Compliance with iron and folic acid supplementation and associated factors among pregnant women in Ethiopia: a systematic review and meta-analysis


  • Meseret B. Fite Department of Public health, Health Science Institute, Wolega University
  • Addisalem D. Denio Department Public health, College of Medicine and Health Sciences, Dire Dawa University, Ethiopia
  • Ahmed Muyhe Department Public health, College of Medicine and Health Sciences, Dire Dawa University, Ethiopia
  • Elias Merdassa Department of Public health, Health Science Institute, Wolega University
  • Markos Desalegn Department of Public health, Health Science Institute, Wolega University
  • Temesgen T. Gurmesa Malaria and NTD directorate, Armauer Hansen Research Institute, Ministry of Health, Addis Ababa, Ethiopia



Compliance, Anaemia, IFAS, Ethiopia


Background: Anaemia is one of the world’s leading cause of disability and the most serious global health issues. Globally about 38% (32 million) pregnant women are anaemic, from which 46.3% (9.2 million) are in Africa.

Methods: Works of articles from PubMed, Medline and Google Scholar journal data-base were considered. Entirely articles allied to compliance and determinants of AFA supplementation were captured. The authors used modified Newcastle-Ottawa quality appraisal rule for cross-sectional works to assess the excellence of the studies for consideration and, tracked preferred reporting items for systematic reviews and meta-analysis guideline. The pooled effect size was calculated with the review manager and compressive meta-analysis software.

Results: Eighteen studies with a total of 6649 pregnant women were included for analysis. Compliance of IFA supplementation in pregnancy in Ethiopia was 46.1%. Women who had experienced counselling on IFAS were 1.16 times, OR:1.16, (95% CI, 0.54, 2.50), knowledge on IFAS were 3.20 times, OR:3.20, (95% CI, 1.31, 7.85), knowledge of anaemia were five times OR:5.10, (95% CI, 1.87, 13.94), fourth visit for ANC were 1.58 times OR:1.58, (95% CI, 0.59, 3.42) and early registration for ANC were three times OR: 3.19, (95% CI, 0.77, 13.26) more likely to have compliance with IFAS compared to their counterpart.

Conclusions: There is low compliance of IFAS in different parts of Ethiopia. Lack of counselling on IFAS, knowledge of IFAS and anaemia, no fourth visit for ANC and timing in ANC registration were factors that hinder compliance of IFAS.


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