Factors associated with non-adherence to prescribed iron supplement use: a study with pregnant women in the city of Rio de Janeiro

Niquini, Roberta Pereira; Bittencourt, Sonia Duarte de Azevedo; Lacerda, Elisa Maria de Aquino; Saunders, Cláudia; Leal, Maria do Carmo

doi:10.1590/1806-93042016000200007

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ORIGINAL ARTICLES • Rev. Bras. Saude Mater. Infant. 16 (2) • Apr-Jun 2016 • https://doi.org/10.1590/1806-93042016000200007 copy

Factors associated with non-adherence to prescribed iron supplement use: a study with pregnant women in the city of Rio de Janeiro

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objectives:

to identify factors associated with non-use of iron supplements (IS) by pregnant women attending National Health System (SUS) prenatal care in the Municipality of Rio de Janeiro.

Methods:

a cross-sectional study was conducted in 2007/2008 with a representative sample of pregnant women using SUS hospitals and basic care in the Municipality of Rio de Janeiro. The group that had gestational age of ≥ 20 weeks at the time of the interview and who had been prescribed IS (n=1407) was subjected to a Poisson multiple regression model to estimate the association between use and independent variables.

Results:

of the 1407 pregnant women, 65% reported use of IS. Younger age, black skin/race, larger number of births, not having received guidance on use of IS, not having tried to obtain IS at the SUS (with a stronger association between pregnant women with lower levels of education and lower household assets indicator - HAI) and not having been able to obtain them at the SUS (amongpregnant women with lower HAI) were significantly associated with non-use.

Conclusions:

the guidance of health professionals regarding use of IS and their regular availability may increase adherence to prescription among pregnant women and prevent iron deficiency anemia.

Key words
Anemia; Anemia, iron-deficiency; Ferrous sulfate; Prenatal care; Pregnancy; Epidemiologic factors

Variables	N	%	CI95%
Age (n=1407)
Adolescents	339	24.1	20.5-28.0
Adults	1068	75.9	72.0-79.5
Race/skin color (n=1407)
White	354	25.1	22.7-27.7
Black	353	25.1	22.1-28.4
Mixed	700	49.8	47.1-52.4
Education (years of schooling) (n=1407)
< 8	455	32.3	28.6-36.2
≥ 8	952	67.7	63.8-71.4
Employment situation (n=1407)
In paid work	466	33.1	29.7-36.8
Without paid work	941	66.9	63.2-70.3
Marital status (n=1407)
Lives with partner	1094	77.8	73.6-81.5
Does not live with partner	313	22.2	18.5-26.4
Number of people in household (n=1407)
1 -3 people	763	54.2	50.7-57.7
4 or more people	644	45.8	42.3-49.3
Household Assets indicator (n=1407)
≤ 1	634	45.0	37.8-52.5
> 1	773	55.0	47.5-62.2
Parity (n=1407)
<1	630	44.8	40.8-48.8
≥1	777	55.2	51.2-59.2
Gestational age at start of prenatal care (weeks) (n=1380)
< 17	916	66.3	62.5-70.0
≥ 17	464	33.7	30.0-37.5
Report of nausea, emesis or pyrosis (n=1407)
No	1297	92.1	90.3-93.6
Yes	110	7.9	6.4-9.7
Obtained IS within SUS network (n=1407)
Successfully tried to obtain IS within SUS network	779	55.4	38.5-71.1
Unsuccessfully tried to obtain IS within SUS network	385	27.3	20.3-35.7
Did not try to obtain IS within SUS network	243	17.3	8.9-30.9
Adequate number of prenatal consults (n=1394)
Yes	1121	80.4	76.5-83.8
No	273	19.6	16.2-23.5
Record of prescription of IS on card (n=1392)
Yes	97	6.9	3.1-14.7
No	1295	93.1	85.3-96.9
Correct guidance on use of IS (n=1407)
Yes	524	37.3	32.3-42.5
No	883	62.7	57.5-67.7
Some guidance on use of IS (n=1407)
Yes	1365	97.0	95.9-97.8
No	42	3.0	2.2-4.1
Diagnosis of anemia reported (n=1407)
Yes	504	35.9	31.9-40.0
No	903	64.1	60.0-68.1
Diagnosis of anemia according to prenatal card record (n=893)
Yes	160	18.0	14.8-21.6
No	733	82.0	78.4-85.2

Variables	PR	CI95%
Age ^† † continuous variable;	0.985^ p<0.05;	0.974-0.996
Race/skin color )
White	1	-
Black	1,259^ p<0.05;	1,021-1,554
Mixed	1,192^* * p<0.20;	0,965-1,473
Education (years of schooling)
< 8	1,265^* ***** p<0.01;	1,084-1,477
≥ 8	1	-
Employment situation
In paid work	1	-
Without paid work	1,228^* ***** p<0.01;	1,096-1,375
Marital status
Lives with partner	1	-
Does not live with partner	0,974	0,829-1,145
Number of people in household
1 -3 people	1	-
4 or more people	1,011	0,872-1,172
Household Assets indicator
≤ 1	1,095	0,938-1,278
> 1	1	-
Parity (n=1407)
<1	1	-
≥1	1,089^* * p<0.20;	0,980-1,210
Gestational age at start of prenatal care (weeks)
< 17	1	-
≥ 17	1,038	0,869-1,240
Report of nausea, emesis or pyrosis
No	1
Yes	1,108	0,869-1,412
Obtained IS within SUS network
Successfully tried to obtain IS within SUS network	1	-
Unsuccessfully tried to obtain IS within SUS network	1,575 ^* ***** p<0.01;	1,199-2,069
Did not try to obtain IS within SUS network	2,256^* ***** p<0.01;	1,710-2,976
Adequate number of prenatal consults
Yes	1	-
No	1,380^* ***** p<0.01;	1,120-1,700
Record of prescription of IS on card
Yes	1	-
No	1,395^* * p<0.20;	0,932-2,089
Correct guidance on use of IS
Yes	1	-
No	1,092^* * p<0.20;	0,946-1,261
Some guidance on use of IS
Yes	1	-
No	1,907^* ***** p<0.01;	1,461-2,489
Diagnosis of anemia reported
Yes	1	-
No	1,118^* * p<0.20;	0,967-1,293
Diagnosis of anemia according to prenatal card record
Yes	1	-
No	1,103	0,800-1,521

Varibles	PR (CI95%) (n=1407)	PR (CI95%^)• • Analysis adjusted after exclusion of most influential observation (nº 370); (n=1406)
Age ^† † continuous variable;	0.983 (0.971-0.996)^ p<0.05;	0.983 (0.971-0.996)^ p<0.05;
Race/skin color
White	1	1
Black	1.245 (1.045-1.484)^ p<0.05;	1.243 (1.045-1.478)^ p<0.05;
Mixed	1.187 (0.984-1.431)	1.192 (0.989-1.438)
Parity
<1	1	1
≥1	1.165 (1.020-1.331)^ p<0.05;	1.172 (1.029-1.335)^ p<0.05;
Some guidance on use of IS
Yes	1	1
No	1.739 (1.195-2.528)^ p<0.05;	1.852 (1.358-2.524)^* ***** p<0.01;
≥ 8 years of schooling and HAI >1
Successfully tried to obtain IS within SUS	1	1
Unsuccessfully tried to obtain IS within SUS	1.376 (0.978-1.936)	1.375 (0.977-1.935)
Did not try to obtain IS within SUS	1.725 (1.292-2.303) ^* ***** p<0.01;	1.722 (1.289-2.299)^* ***** p<0.01;
< 8 years of study and HAI > 1
Successfully tried to obtain IS within SUS	1	1
Unsuccessfully tried to obtain IS within SUS	1.538 (0.950-2.489)	1.544 (0.954-2.500)
Did not try to obtain IS within SUS	2.967 (2.108; 4.175)^* ***** p<0.01;	2.979 (2.116-4.192)^* ***** p<0.01;
≥ 8 years of study and HAI ≤ 1
Successfully tried to obtain IS within SUS	1	1
Unsuccessfully tried to obtain IS within SUS	1.642 (1.095-2.463)^ p<0.05;	1.720 (1.147-2.579)^* ***** p<0.01;
Did not try to obtain IS within SUS	2.369 (1.722-3.258) ^* ***** p<0.01;	2.361 (1.717-3.247)^* ***** p<0.01;
< 8 years of study and HAI ≤ 1
Successfully tried to obtain IS within SUS	1	1
Unsuccessfully tried to obtain IS within SUS	2.043 (1.496-2.790)^* ***** p<0.01;	2.047 (1.498-2.795)^* ***** p<0.01;
Did not try to obtain IS within SUS	2.829 (1.928-4.151)^* ***** p<0.01;	2.804 (1.911-4.114)^* ***** p<0.01;

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[TFN1] ^*
p<0.20;

[TFN2] ^**
p<0.05;

[TFN3] ^***
p<0.01;

[TFN4] ^†
continuous variable;

[TFN5] PR= Prevalence ratio.