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Peri-conceptional folic acid supplementation: A Cross-Sectional Study to Assess the Awareness, Knowledge, Use and Associated Factors Among Pregnant Women Attending Antenatal Care in Two Secondary Health Care Facilities, Southwest Region, Cameroon

Author(s): Confidence A. Alemajo, Gregory E. Halle-Ekane, Elvis A. Nkengasong, Emmanuel A. Asongalem

Background: Neural tube defects(NTDs) are among the most common birth defects, contributing to miscarriages, infant mortality, severe congenital abnormalities, and serious disabilities. The protective effect of peri-conceptional folic acid (PFA) supplementation in reducing the risk of NTDs and other adverse pregnancy outcomes has been scientifically confirmed.

Methods: A cross-sectional study was conducted using a structured questionnaire administered to 393 pregnant women seeking routine antenatal care between February to April 2020. Multivariate logistic regression was used to model factors associated with awareness, knowledge, and use of PFA.

Results: Approximately 55% of women reported that they had heard of folic acid and only 6.1% had knowledge of folic acid (its benefit in preventing birth defects and the appropriate time to start using it). However, only 5.1% reported that they started using folic acid before pregnancy. Folic acid awareness showed a significant relationship with university education and above (OR=4.30, 95% CI [2.60, 7.30], P<0.001). There was also a significant difference in the odds of knowledge among those with a university education and above (OR=5.06, 95% CI [1.65, 19.0], P=0.0076). There was a statistically significant difference in the odds of awareness and knowledge of folic acid among women who had a history of folic acid education from a healthcare provider before pregnancy compared to those who did not, (OR=23.7, 95% CI [4.84, 430], P=0.002), (OR=12.0, 95% CI [4.31, 35.1], P<0.001) respectively. Even though women who planned their pregnancy (OR=4.89, 95% CI [0.84, 93.9]), received pre-conceptional folic acid education (OR=5.11, 95% CI [1.47, 18.7], and had a history of an unsuccessful pregnancy (OR=2.61, 95% CI [0.86, 8.65], had higher odds of the folic acid use, these relationships were not statistically significant.

Conclusion: These results support the fact that women with a high level of education and those with pre-conceptional folic acid education from a healthcare provider are more likely to be aware and have knowledge of folic acid, though this does not translate into use. Antenatal and population-based health education strategies and campaigns by health care providers targeting pregnant and women of childbearing age, especially those with low levels of education may improve use.

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