Folate intake and access to folic acid supplementation among adolescent pregnant Women attending antenatal clinic at Huruma sub county Hospital, Eldoret Kenya

Abstract

Background: Adequate intake of micronutrients among pregnant women can prevent serious birth defects, reduce the risk of premature and low birth weight infants and support maternal health. Adolescent pregnancy poses a higher risk because of double burden of meeting their own dietary folate intake needs and the foetus. Folate deficiency results in increased occurrence and recurrence of neural tube defects including spinabifida, placenta abruption, pre-eclampsia, spontaneous abortion, stillbirth, preterm delivery and low birth weight. Most research on folate intake has been done internationally with more focus on the general women population and little data on adolescents. There is need to do more research locally and consequently find out whether pregnant adolescents meet the required threshold. Objective: To determine the prevalence of inadequate folate intake, extent of access to optimal Folic acid supplements and identify the barriers to dietary intake and uptake of folic acid supplementation among adolescent pregnant women attending antenatal clinic at Huruma Sub County Hospital. METHODS: Study population was adolescent pregnant women attending Ante natal Clinic (ANC). Descriptive cross sectional study design was used. Data on maternal characteristics was collected using a structured questionnaire of both open and close ended questions. A Food Frequency Questionnaire (FFQ) was used to collect data on folate intake. Focus Group Discussion (FGD) with health providers was used to get perceptions on potential barriers to folic acid use and supplementation. Nutrient calculator was used to estimate nutrient intake. Adequacy of intake was based on comparison to Estimated Average Requirement (EAR). Descriptive and inferential statistics were analyzed using SPSS version 24. Percentages, frequency distribution, measures of central tendency and dispersion were used to describe data. Chi square was used to determine the factors associated with inadequate intake. Qualitative data was analyzed thematically and presented using descriptive narrations aided by NVIVO version 11. Results: A total of 220 respondents were enrolled in the study. The average age was18 (17, 19).Slightly more than half of the respondents were married and had primary level of education at 129(58.6%) and 118(53.9%) respectively. Majority of the respondents 158(71.8%) were earning between Kshs.1000 -3000 monthly. Half of the respondents 115(52.3%) were in the first trimester of pregnancy. The prevalence of inadequate folate intake was 167(75.9%).Majority of the respondents 161(74.2%) reported cost of folate rich food as expensive. Side effects of folic supplements were significantly associated with supplement use (χ2(101.6)=3 P=0.01) (P<0.05). Nutrition education was a significant factor affecting adequate folate intake (OR: 95% CI: 1.497: 1.007-2.931).Barriers to ideal supplements included lack of Access to information, inadequate supply of supplements, inconsistent supply and adherence as reported in the FGD with the health providers. Conclusion: The study found that the prevalence of inadequate folate intake was high at 75.9% and that there was lack of an ideal supplementation programme. Recommendations: Better structures to enhance policies on micronutrient supplementation and proper timing of nutrition education for better practices by the mothers.