DOI: 10.12688/openresafrica.16765.1 ISSN: 2752-6925

Magnitude and Determinants of Adherence to Iron–Folic Acid Supplementation among Pregnant Women in Bosaso, Somalia: A Facility-Based Cross-Sectional Study

Ismail Mahamoud Yousuf, Abdihakim Hussein Osman, Yahye Abdalle Jama, Awo Mohamed Kahiye, Mahamed Barkhad Siciid, Xaawo Yaasiin Shire, Mucaad Cabdiwaasac Bilal
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Background Iron–folic acid supplementation (IFAS) is essential for preventing maternal anemia and improving pregnancy outcomes, yet adherence remains suboptimal in Somalia. This study assessed IFAS adherence and associated factors among pregnant women attending antenatal care services in Bosaso, Puntland State of Somalia. Methods A facility-based cross-sectional study was conducted among 400 pregnant women attending selected hospitals and maternal and child health centers in Bosaso. Data were collected using a structured interviewer-administered questionnaire. Descriptive statistics and bivariable and multivariable logistic regression analyses were performed. Statistical significance was set at p < 0.05. Results Of the 400 participants, 198 (49.5%) were adherent to IFAS, while 202 (50.5%) were non-adherent. Good maternal knowledge of anemia was significantly associated with higher odds of adherence (AOR = 1.81, 95% CI: 1.02–3.21; p = 0.044). Women whose husbands had secondary education had lower odds of adherence compared with those whose husbands had no formal education (AOR = 0.41, 95% CI: 0.20–0.82; p = 0.012). ANC initiation during the first trimester (AOR = 0.07, 95% CI: 0.02–0.26; p < 0.001) and second trimester (AOR = 0.14, 95% CI: 0.03–0.56; p = 0.006) was associated with lower adherence compared with third-trimester initiation. Conclusions IFAS adherence among pregnant women in Bosaso was suboptimal. Maternal anemia knowledge, husband’s education, and timing of ANC initiation were significant determinants. Strengthening ANC counseling, maternal health education, and male involvement may improve IFAS adherence and maternal health outcomes.

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