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.