ATTITUDE AND PERCEPTION OF WOMAN TOWARD THE USE OF IRON SUPPLEMENTION DURING PREGNANCY: A CASE STUDY OF PHC SANGARU BAJOGA, FUNAKAYE L.G.A, GOMBE STATE NORTH EASTERN NIGERIA.

CHAPTER ONE
INTRODUCTION

1.1 BACKGROUND TO THE STUDY
Nutrition is integrated in the health care sector transformation plan form of micro nutrient intervention to prevent the occurrence of anemia and improve the nutritional status of mother during pregnancy (Dermis 2019). Iron Supplements are essential micro nutrients for normal physiological function, growth and developments as well as maintenance of life. However like many other nutrients, their demand increase during pregnancy creating a need for supplementation to meet requirement in pregnancy (Wanjira et al 2018). The high nutrition demand during pregnancy may not be made by regular diet because of insufficient amount and or low bio availability especially in the developing countries (Wanjira et Al 2018). However, adherence to the current recommendation in the local population in factor associated with taking iron supplementation during pregnancy found compliance was rather high it knowledge of subjects was low, suggesting increasing afford is required to mobilize health workers to distribute supplement properly (Theng 2017). Due to this proportion deficiency in iron or folic acid causes an imbalance between demand and supply resulting in anemia. Iron and folic acid and other micro nutrient deficiency highly prevalent in Kenya, particularly at crucial stages of the life cycle such as pregnancy which can negativity impact the health of both mothers and children before, during and after birth (Wanjira et Al 2018).
During pregnancy it is important to take adequate nutrition which is essential for optimal growth of the fetus and decrease in the incidence of congenital abnormalities. Adequate dietary intake of protein and energy is not enough for normal weight of newborn, decrease in vitamins and minerals can adversely affect the weight of the newborn. (Saadeldin 2022). Pregnant women at particular risk of iron and folic acid deficiency due to their increase requirements. World health organization in national guideline recommend all pregnant women should receive a daily dose 60mg iron + folic acid for six month and additional three month in setting where anemia prevalence is highly, to prevent maternal anemia, puerperal sepsis, low birth weight, small babies for gestational age and maternal anemia can be reduce by adequate intake of iron and folic acid supplement during pregnancy. A lot of study shows the importance of relationship between iron and folic acid supplement and multivitamin intake and the socio economic factors as age, level of education, marital status, parity, economic status and prenatal (Saadeldin 2022).
1.2 STATEMENT OF THE PROBLEM

Globally 70% of women and 41% in Nepal didn't took iron and folic acid supplement during their most recent pregnancy, in Ethiopia, anemia affect 1.62 billion people and affect about 41.8% of pregnant women, 17.2 Million of pregnant women in Africa ( Demos et Al 2019).
Thus, despite the fact that routine iron supplement during pregnancy has been almost universally recommended to prevent maternal anemia in developing countries over the past 3 decades. The prevalence of anemia in pregnancy in Cameroon, iron in women was estimated at 50.9% in 2004. Iron deficiency anemia during pregnancy increase the risk of maternal mortality, fetal morbidity and mortality, preterm delivery, and low birth weight (Demis et al 2019). A Meta analysis reported that use of iron and folic acid supplements could eliminate 50%of iron deficiency anemia in pregnant women and also there is 19% reduction in the risk of low birth (Demis et al 2019). Nationally, only 5% of pregnant women did not take any folic acid tablet during their must pregnancy.

1.3 AIM OF THE RESEARCH
The aim of this research work is limited to attitude and perception of women toward the use of iron supplementation during pregnancy in primary health care Sangaru, Funakaye local government area Gombe state

1.3 RESEARCH OBJECTIVES

• To assess the attitude and perception of women toward the use of iron supplementation among pregnant women attending primary health care center PHC Sangaru.
• To assess the factors responsible for the attitude and perception of women toward the use of iron supplementation among pregnant women attending primary healthcare Sangaru.
• To find out the consequences of the non adherence to iron supplementation during pregnancy among pregnant women attending antenatal care center Sangaru.



1.4 RESEARCH QUESTIONS

1. What is the attitude and perception of women toward use of iron supplementation during pregnancy?
2. How to assess the factors responsible for the attitude and perception of women toward use of iron supplementation?
3. What are the consequences of non adherence to iron supplementation during pregnancy?

1.5 SIGNIFICANCE OF THE STUDY
The study would deliberately expos the perception of women toward the use of iron supplement during pregnancy, thus, finding the study could also enlighten and reshaped the perception of pregnant women toward the use of iron supplement, as well as provide a tool of mitigating the problem among them to discourage negative consequences related to use of iron supplement. The finding of study will add more knowledge and information to the already existing literature in community health profession by serving as framework which will enable health worker in their interventions through advocacy, mobilization, health education tips and achievement optimum health and also information drifted will be useful in designing a plan of action and implementation of policies related to use of iron supplement. The result from the work will also be important to future researchers who Is to carry out a research on subject matters serving as reference material.

1.7 OPERATIONAL DEFINITION OF TERMS
• IRON: an essential mineral that play a role in various bodily functions.
• ATTITUDE: Behavior or way in which a person view someone or something.
• PERCEPTION: The way person believes something
• WOMEN: An adult female
• SUPPLEMENT: A textual matter added to an ingredients
• STATE: Place where people leaves



CHAPTER TWO
LITERATURE REVIEW

2.1 Conceptual Review

In 2004 Ethiopia adopted the global iron and folic acid supplement strategy targeting to reduce the prevalence of iron deficiency anemia in women of reproductive age. More than 40% and almost one third of pregnant women are anemic worldwide and in Ethiopia respectively. Iron supplementation is important to prevent anemia during pregnancy in developing countries including Ethiopia (Getanch et al 2021). Physiological changes during pregnancy, fetal growth and development increases the requirement of iron and folic acid. The increase demand of this nutrient is not meet through diet alone due to the increased bioavailability of nutrient during pregnancy. Pregnant women are vulnerable to iron deficiency due to the fact that more iron is needed primarily to supply the growing fetus and placenta and to increase the maternal red cell mass (Vincent et al 2023) Daily supplementation throughout pregnancy, beginning as early as possible after conception is recommended in all setting. Despite its proven efficiency and wide inclusion in antenatal care programs, the use of iron supplementation has been limited in programs settings, possible reason for this include lack of compliance and variable availability of the supplements at community level. (WHO 2023). The percentage of women who consumed any iron containing supplement during their current or previous pregnancy with the past 2 years. If provide information about the quality and average of perinatal medical service (WHO 2023).
Daily iron supplementation is currently recommended by WHO as part of antenatal care, to reduce the risk of iron deficiency is suggested that the supplement contains 50_60mg of iron with the higher dose preferred in setting where anemia in pregnant women is a severe public health problem (>40%) along which 400mg of folic acid (WHO 2023).
Attitude are often the result of experience or upbringing, they can have a powerful influence over behavior and affect how people act in various situations. While attitude are enduring, they can also change the main component of attitude are cognitive, affecting and behavioral, which means they incorporate thoughts feeling and action of pregnant women in iron supplement.