Adherence to iron–folic acid supplementation among pregnant women in east africa: a systematic review and meta-analysis

Iron and folic acid deficiency anemia remains a major global public health problem, accounting for approximately 1.45% of all disability-adjusted life years (DALYs). It is widely recognized as a significant contributor to the high levels of maternal and perinatal morbidity and mortality worldwide. Adequate adherence to iron and folic acid supplementation during pregnancy is essential for preventing anemia and reducing its related health complications. Although numerous studies have been conducted in different settings, their findings have been inconsistent and insufficient to inform clear interventions. Therefore, this systematic review and meta-analysis aimed to estimate the pooled prevalence of adherence to iron and folic acid supplementation and to identify its determinants among pregnant women in East Africa. The protocol for this systematic review and meta-analysis was registered in the PROSPERO database with the registration number CRD420261335746. An extensive literature search was conducted using several international databases, including PubMed, Google Scholar, the Cochrane Library, and Embase. The meta-analysis was conducted using a random-effects model, and all statistical analyses were performed using STATA version 14 for Windows. The I² statistic was used to assess heterogeneity among the included studies, while Egger’s test was applied to evaluate potential publication bias. This systematic review and meta-analysis included a total of 26 eligible studies. The pooled adherence to iron–folic acid supplementation among pregnant women in East Africa was 58% (95% CI: 57.24–58.76) and heterogeneity among studies was ( I² = 99.5%, p < 0.001 ) . This study identified several significant determinants of adherence, including counseling on the importance of iron–folic acid supplementation (AOR = 2.41; 95% CI: 1.73–3.09), good knowledge of iron–folic acid supplementation (AOR = 1.80; 95% CI: 1.43–2.17), good knowledge about anemia (AOR = 3.19; 95% CI: 1.87–4.52), history of anemia during the current pregnancy (AOR = 2.77; 95% CI: 1.40–4.13), and attending four or more antenatal care visits (AOR = 4.14; 95% CI: 1.87–6.42). The review found that adherence was moderate; however, it remains below the optimal level recommended by current guidelines. The findings revealed that counseling, good knowledge of iron–folic acid supplementation, knowledge of anemia, history of anemia during the current pregnancy, and attending four or more antenatal care visits were significantly associated with adherence. Healthcare providers should strengthen antenatal care counseling by emphasizing the benefits and proper use of iron–folic acid supplementation and addressing side effects. Health systems and policymakers should promote early antenatal care initiation and completion of at least four antenatal care visits to improve adherence. Not applicable.