Determinants of Compliance to Iron Supplementation During Pregnancy in Rural Bangladesh : Secondary Data Analysis of the MINIMat Trial

Abstract: Background: Although efforts to reduce iron deficiency during pregnancy have been made, programmes often struggle with their participants’ compliance and effectiveness is low. Nevertheless, there is only little information about determinants of compliance. The aim of this thesis is to investigate which factors contribute to women’s compliance to iron supplementation during pregnancy in rural Bangladesh. Methods: Secondary analysis of data collected within a randomized trial in Matlab, Bangladesh (MINIMat trial). 4436 pregnant women were assigned to six micronutrient supplementation groups. Questionnaires were administered and anthropometric measurements were taken. Compliance was measured using the eDEM® counting device which recorded every time a pill bottle was opened. Results: In linear regression maternal age, socio economic status (SES) and education showed a positive association with compliance (p<0.001). Parity showed a negative association (p=0.045). Knowledge of effects of iron supplementation and perception of importance of iron supplementation were not significantly associated with compliance. Experiencing positive effects of iron supplementation was related to higher compliance to iron supplementation, while experiencing nausea was related to lower compliance to iron supplementation (p<0.001). Dislike of the tablets (p<0.001) and other reasons that were not specifically mentioned (p=0.015) were significantly associated with a decrease in compliance. Conclusion: Pregnant women’s compliance to iron supplementation was determined by different factors. Educating women about anaemia, iron deficiency and iron supplementation should not be the only strategy to achieve high compliance. Development of supplements that cause fewer side effects should be considered and more research investigating determinants of compliance should be performed.