Published: 2021-03-25

Nutrition counselling and knowledge on iron and folic acid supplementation among pregnant women in Nyeri County, Kenya

Henry Mburu Ng'the, Douglas Nderitu, Stephanie Wanja


Background: In the world, a deficiency of iron is the most common nutrition disorder affecting more than 30% of the global populace more so children and women. Countries in the developing world are working in programs on implementing the iron and folic acid supplementation (IFAS) although the effectiveness of curbing anemia is usually affected by non-compliance to iron and folic acid supplements by women who are pregnant. The government of Kenya has come up with strategies to deal with anemia which include supplementation of iron and folic acid, implementation of focused antenatal care even though they have encountered a few hurdles resulting to sub optimal coverage and low levels of compliance.

Methods: This was a mixed method study whereby both qualitative and quantitative data was analysed. A sample size of 385 pregnant women were interviewed. Data was collected using questionnaires. Descriptive statistics were used to analyze the quantitative data which was presented in form of frequency and percentage tables, bar graphs and pie charts. 

Results: Results show that 96% of the expectant women indicated that they were advised to take fruits while 86% indicated that they were advised to take green vegetables. This shows that pregnant women in the study had good knowledge of their dietary needs.

Conclusions: The study concludes that expectant women had high nutrition knowledge on foods that raise the haemoglobin levels during gravidity.


Iron, Folic acid, IFAS, Expectant women, Anemia, Gravidity

Full Text:



Miller JL. Iron deficiency anemia: a common and curable disease. Cold Spring Harbor Perspectives in Medicine. 2013;3(7):101-17.

World Health Organisation. Guideline Daily iron and folic acid supplementation in pregnant women. 2012. Available from: Accessed on 20 Oct, 2020.

Ministry of Health. National Iron and Folic Acid Supplementation Communication Strategy. Government of Kenya, Nairobi. 2013.

Kamau M, Kimani S, Mirie W. Counselling on iron and folic acid supplementation (IFAS) is associated with improved knowledge among pregnant women in a rural county of Kenya: a cross-sectional study. AAS Open Res. 2018;21(1):14-27.

World Health Organisation. The global prevalence of anemia in 2011 WHO Library Cataloguing-in-Publication Data. 2011. Available from: Accessed on 20 Oct, 2020.

Auerbach M. Commentary: Iron deficiency of pregnancy - A new approach involving intravenous iron. Reprod Health. 2018;15(1):96-100.

Ibrahim ZM, El-Hamid SABD, Mikhail H, Khattab MS. Assessment of Adherence to Iron and Folic Acid Supplementation and Prevalence of Anemia in Pregnant Women. Med J Cairo University. 2011;79(2):115-21.

Okube OT, Mirie W, Odhiambo E, Sabina W, Habtu M. Prevalence and Factors Associated with Anaemia among Pregnant Women Attending Antenatal Clinic in the Second and Third Trimesters at Pumwani Maternity Hospital, Kenya. Kenya. Open J Obstet Gynecol. 2015;6(4):16-27.

Dinga L. Factors associated with adherence to iron/folate supplementation among pregnant women attending antenatal clinic at Thika District Hospital in Kiambu County, Kenya [Masters Dissertation, University of Nairobi]. 2013. Available from: to Iron/Folate.pdf?sequence=3. Accessed on 20 Oct, 2020.

World Health Organisation. Conclusions of a WHO Technical Consultation on folate and vitamin B 12 deficiencies. Food Nutri Bull. 2008;29(3):15-25.

Ministry of Health. National Policy guideline on Combined Iron and Folic acid. 2013. Available from: Accessed on 20 Oct, 2020.

World Health Organisation. Standards for Maternal and Neonatal Care Standards Integrated Management of Pregnancy and Childbirth (IMPAC). 2006. Available from: Accessed on 20 Oct, 2020.

Siabani S, Siabani S, Siabani H, Moeini Arya M, Rezaei F, Babakhani M. Determinants of Compliance with Iron and Folate Supplementation Among Pregnant Women in West Iran: A Population Based Cross-Sectional Study. J Family Reprod Health. 2018;012(4):197-203.

Bin NY, Dibley MJ, Aguayo VM. Iron-folic acid supplementation during pregnancy reduces the risk of stunting in children less than 2 years of age: A retrospective cohort study from Nepal. Nutrients. 2016;8(2):67.

Birhanu Z, Chapleau GM, Ortolano SE, Mamo G, Martin SL, Dickin KL. Ethiopian women’s perspectives on antenatal care and iron-folic acid supplementation: Insights for translating global antenatal calcium guidelines into practice. Maternal Child Nutr. 2018;14(3):110-45.

Kassa ZY, Awraris T, Daba AK, Tenaw Z. Compliance with iron folic acid and associated factors among pregnant women through pill count in Hawassa city, South Ethiopia: A community based cross-sectional study. Reprod Health. 2019;16(1):14.

Sing SR, Ratanasiri T, Thapa P, Koju R, Ratanasiri A, Arkaravichien T, Arkaravichien W. Effect of knowledge and perception on adherence to iron and folate supplementation during pregnancy in Kathmandu, Nepal. J Medi Asso Thailand. 2014;97(10):67-S74.

Nechitilo M, Nguyen P, Webb‐Girard A, Gonzalez‐Casanova I, Martorell R, DiGirolamo A, Ramakrishnan U. A qualitative study of factors influencing initiation and adherence to micronutrient supplementation among women of reproductive age in Vietnam. Food Nutri Bull. 2016;37(4):461-74.

Shewasinad S, Negash S. Adherence and Associated Factors of Prenatal Iron Folic Acid Supplementation among Pregnant Women Who Attend Ante Natal Care in Health Facility at Mizan-Aman Town, Bench Maji Zone, Ethiopia, 2015. J Pregnancy Child Health, 2017;04(03):1-15.

Tinago CB, Ingram LA, Blake CE, Frongillo EA. Individual and structural environmental influences on utilization of iron and folic acid supplementation among pregnant women in Harare, Zimbabwe. Maternal Child Nutri. 2017;13(3).

Oluleke MO, Ogunwale AO, Arulogun OS, Adelekan AL. Dietary intake knowledge and reasons for food restriction during pregnancy among pregnant women attending primary health care centers in Ile-Ife, Nigeria. Int J Popul Studies. 2016;10(20):11-6.

Shah S, Sharma G, Shris L, Shah S, Sharma M, Sapkota N. Knowledge on dietary patterns among pregnant women attending antenatal care check-up in Narayani hospital, Nepal. Int J Comm Med Public Health. 2017;4:1466.

Nagi R, Sahu S, Nagaraju R. Oral health, nutritional knowledge, and practices among pregnant women and their awareness relating to adverse pregnancy outcomes. J Indian Academy Oral Med Radiol. 2016;28(4):396.

Rai SS, Ratanasiri T, Thapa P, Koju R, Ratanasiri A, Arkaravichien T, Arkaravichien W. Effect of Knowledge and Perception on Adherence to Iron and Folate Supplementation during Pregnancy in Kathmandu, Nepal. J Medi Asso Thailand, 2014;97(10):S67-74.

Malhotra N, Upadhyay RP, Bhilwar M, Choy N, Green T. The Role of Maternal Diet and Iron-folic Acid Supplements in Influencing Birth Weight: Evidence from India’s National Family Health Survey. J Trop Pediat. 2014;60(6):454-60.

Kavle JA, Landry M. Addressing barriers to maternal nutrition in low- and middle-income countries: A review of the evidence and programme implications. Matern Child Nutr. 2018;14(1):e12508.

Lisa G, Sverre P, Annhild M. Experiences with nutrition-related information during antenatal care of pregnant women of different ethnic backgrounds residing in the area of Oslo, Norway. Midwifery. 2013;29:10.

Bookari K, Yeatman H, Williamson M. Informing Nutrition Care in the Antenatal Period: Pregnant Women’s Experiences and Need for Support. BioMed Res Int. 2017;12(4):1-16.