Individual and contextual-level factors associated with iron-folic acid supplement intake during pregnancy in Ethiopia: a multi-level analysis

Melaku Yalew, Shiferaw Getachew, Keriya Mohammed, Hailu Hankarso, Adane Bayile, Shambel Dessale Asmamaw, Mesfin Getahun Assefa, Getaw Walle Bazie, Wondwosen Mebratu, Bereket Kefale, Yitayish Damtie, Mastewal Arefaynie, Tesfaye Birhane, Reta Dewau, Nigus Cherie, Elsabeth Addisu, Kefale Mitiku, Fentaw Tadese, Teklehaimanot Fentie Wendie, Adane Habtie, Tefera Chane Mekonnen, Sisay Eshete Tadesse, Getachew Tadesse Bedane, Yitbarek Wasihun, Tilahun Degu Tsega, Mekuanint Taddele, Zenebe Tefera, Bezawit Adane, Birhanu Wagaye, Fanos Yeshanew Ayele, Aregash Abebayehu Zerga, Abebaw Molla, Biruk Desalegn, Mengesha Birkie, Bekalu Bewket, Belete Kassa Alemu, Segenet Zewdie, Meseret Kefale Tsegaye, Abebayehu Bitew, Kassu Mehari, Lemma Derseh

Anemia is still one of the major public health problems in many developing countries including Ethiopia. Thus, this study aimed to assess individual and contextual-level factors associated with iron-folic acid supplement intake during pregnancy in Ethiopia. A secondary analysis was done on the 2019 mini-Ethiopian Demographic and Health Survey (EDHS) dataset. A total of 3,927 pregnant women who gave birth five years before the survey were included in the analysis. Multi-level mixed-effect logistic regression analysis was done by STATA/SE version 14.0 to identify individual and contextual-level factors. Adjusted Odds Ratio (AOR) with 95% Confidence Interval (CI) was used to show the strength and direction of the association. The level of statistical significance was declared at a P value less than 0.05. Those primary educated [AOR = 1.83, 95% CI: (1.24, 2.74)], secondary educated [AOR = 2.75, 95% CI: (1.57, 4.824)], women who had greater than 5 living children [AOR = 2.02, 95% CI: (1.25, 3.27)], women who had ANC visit [AOR = 21.26, 95% CI: (13.56, 33.32)] and women who lived in a cluster with high proportion of women had ANC visit [AOR = 1.72, 95% CI: (1.17, 2.54)] and women who lived in Somali [AOR = 0.44 0.73, 95% CI: (0.22, 0.87)] were significantly associated with iron-folic acid intake during pregnancy. Both individual and contextual-level factors were significantly associated with iron-folic acid intake during pregnancy. From individual-level factors: education status of women, the total numbers of living children, and ANC follow-up are significant and from contextual-level factors: region and living in a high proportion of women who had ANC follow-up were found to have a statistically significant association. Promoting women's education and maternal health services like ANC and intervention targeting the Somali region would be the recalled area of the government.