Skip to main content
Log in

Utilization of Folic Acid and Iron Supplementation Services by Pregnant Women Attending an Antenatal Clinic at a Regional Referral Hospital in Kenya

  • Published:
Maternal and Child Health Journal Aims and scope Submit manuscript


To determine utilization of iron and folic acid supplementation services among pregnant women in Kenya. A cross sectional study was conducted at Nyeri Hospital, a regional referral hospital in central Kenya. Women attending the antenatal clinic were selected through systematic sampling. A semi-structured questionnaire was administered to collect information on utilization of folic acid and iron supplementation services. Women who ingested folic acid or iron supplements for >4 days in a week were considered “highly compliant”. The health worker in-charge of the antenatal clinic was interviewed about the frequency of supplement stock-outs during the past year. Haemoglobin concentration was measured directly from one drop of capillary blood and measured using portable HEMOCUE B-Hb photometer. Of the 381 women interviewed, only 23.6 % obtained antenatal care in the first trimester; 69.3 and 51.2 % received folic acid and iron supplements, respectively. However, only half (45–58 %) received any information about supplementation. Most women were initiated on folic acid (80.7 %) or iron (67.7 %) after 12 and 16 weeks of gestation, respectively, well after the recommended time period. However, more than 80 % of those who received folic acid and iron were highly compliant. Stock-outs were common at the facility. Of 361 women tested for Hb level, the prevalence of anaemia (Hb levels < 11 g/dl) was 7.8 %. Health workers need to better explain the importance of supplements to pregnant women. Women who come late to antenatal clinic miss opportunities to start supplementation early in pregnancy. Problems with supply chain management exacerbate the problem.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others


  1. Rasmussen, K. (2001). Is there a causal relationship between iron deficiency or iron-deficiency anemia and weight at birth, length of gestation and perinatal mortality? Journal of Nutrition, 131, 590S–603S.

    PubMed  CAS  Google Scholar 

  2. Wardlaw, M., Jeffrey, S., & Robert, A. (2004). Perspectives in Nutrition 6th Edition (pp. 343–346). New York: McGraw-Hill.

    Google Scholar 

  3. Lourdes, G., García, M., & Cynthia, E. (2008). The use of folic acid for the prevention of birth defects in Puerto Rico. Ethn Dis. Spring, 18, 168–171.

    Google Scholar 

  4. Wharton, B., & Booth, I. (2001). Fortification of flour with folic acid. British Medical Journal, 323, 1198–1199.

    Article  PubMed  CAS  Google Scholar 

  5. Ministry of Public Health and Sanitation. (2008). The Kenya National Technical Guidelines for Micronutrient Deficiency Control. Government of Kenya.

  6. WHO & CDC. (2005). Assessing the iron status of populations. Report of a joint World Health Organization/Centers for Disease Control and Prevention technical consultation on the assessment of iron status at the population level (pp. 1–30). Geneva, Switzerland: World Health Organization and Centers for Disease Control and Prevention.

  7. Binetou, C., & Robert, T. (2007). Determinants of compliance with iron supplementation among pregnant women in Senegal. Public Health Nutrition, 11(6), 596–605.

    Google Scholar 

  8. Aikawa, R., Masamine, J., Khan, C., Nguen, Yun Z., Colin, W., & Mi Kyung, L. (2006). Why do adult women in Vietnam take iron tablets? Biomed Central, 6, 144.

    Google Scholar 

  9. Mora, J. (2002). Iron supplementation: Overcoming technical and practical barriers. Journal of Nutrition, 132(4 Suppl), 853S–855S.

    PubMed  CAS  Google Scholar 

  10. Galloway, R., & McGuire, J. (1994). Determinants of compliance with iron supplementation: Supplies, side effects, or psychology? Social Science and Medicine, 39(3), 381–390.

    Article  PubMed  CAS  Google Scholar 

  11. Galloway, R., Dusch, E., Elder, L., Achadi, E., Grajeda, R., & Hurtado, E. (2002). Women’s perceptions of iron deficiency and anemia prevention and control in eight developing countries. Social Science and Medicine, 55, 529–544.

    Article  PubMed  Google Scholar 

  12. Oluwatoyin, E. (2000). Community attitudes to pregnancy, anemia, iron and folate supplementation in urban and rural Lagos, south-western Nigeria. Midwifery, 16, 89–95.

    Article  Google Scholar 

  13. Saerah, S., & Hanafiah, M. (1998). Compliance towards Iron Tablet Supplement among Pregnant Women in Government Maternal and Child Clinic in Kinta District. Malaysian Journal of Community Health: Perak Darul Ridzuan September.

    Google Scholar 

  14. Aguayo, V., Kone, D., Bamba, S., Diallo, B., Sidibe, Y., & Traore, D. (2005). Acceptability of multiple micronutrient supplements by pregnant and lactating women in Mali. Public Health Nutrition, 8, 33–37.

    Article  PubMed  Google Scholar 

  15. Pamela, L., David, D., Ellen, V., Shiela, V., & Ofelia, L. (2007). Iron supplementation compliance among pregnant women. Cambridge Journal, 11, 1.

    Article  Google Scholar 

  16. Dairo, M., & Lawovin, T. (2006). Demographic factors determining compliance to iron supplementation in pregnancy in Oyo State, Nigeria. Nigerian Journal of Medicine, 15, 241–244.

    PubMed  CAS  Google Scholar 

  17. Bharati, K., Parul, C., Steven, C., & Subarna, K. (2009). Determinants of compliance to antenatal micronutrient supplementation and women’s perceptions of supplement use in rural Nepal. Journal of Public Health Nutrition, 13, 82–90.

    Google Scholar 

  18. Ekstrom, E., Kavishe, F., Habitcht, J., Frongillo, E., Rasmussen, K., & Hemed, L. (1996). Adherence to iron supplementation during pregnancy in Tanzania: Determinants and hematological consequences. American Journal of Clinical Nutrition, 64, 368–374.

    PubMed  CAS  Google Scholar 

  19. Padmanabhan, R. (2006). Etiology, pathogenesis and prevention of neural tube defects. Congenital Anomalies, 46, 55–67.

    Article  PubMed  CAS  Google Scholar 

  20. Berry, R., Li, Z., Erickson, J. D., et al. (1999). Prevention of neural tube defects with folic acid in China. China-US Collaborative Project for neural tube defect prevention. New England Journal of Medicine, 341, 1485–1490.

    Article  PubMed  CAS  Google Scholar 

  21. World Health Organisation. (2006). Iron and Folic acid Supplementation. Standards for Maternal and Neonatal Care. Integrated Management of Pregnancy and Childbirth (IMPAC) (Vol. 1.8, pp. 1–6). Geneva, Switzerland: World Health Organization. Department of Making Pregnancy Safer (MPS).

  22. WHO and CDC. (2008). Worldwide prevalence of anemia 1999–2005 Global data base on anemia.

  23. Gies, S., Brabin, B., Yassin, M., & Cuevas, L. (2003). Comparison of screening methods for anaemia in pregnant women in Awassa, Ethiopia. Tropical Medicine & International Health, 8, 301–309.

    Article  CAS  Google Scholar 

  24. Sven, G., Bjørg, E., Per, B., Rolv, T., Peter, G., & Gunnar, K. (2001). Anemia in pregnancy in the highlands of Tanzania. Acta Obstetricia et Gynecologica Scandinavica, 80(1), 18–26.

    Article  Google Scholar 

Download references


We would like to thank the following for their support and contributions: the management of Nyeri Provincial General Hospital, the clients who sought antenatal care at the hospital during the study period, Jomo Kenyatta University of Agriculture and Technology and finally the Kenya Field Epidemiology and Laboratory Training Program in the Ministry of Public Health and Sanitation Kenya for financial support.

Author information

Authors and Affiliations


Corresponding author

Correspondence to L. Maina-Gathigi.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Maina-Gathigi, L., Omolo, J., Wanzala, P. et al. Utilization of Folic Acid and Iron Supplementation Services by Pregnant Women Attending an Antenatal Clinic at a Regional Referral Hospital in Kenya. Matern Child Health J 17, 1236–1242 (2013).

Download citation

  • Published:

  • Issue Date:

  • DOI: