Cultural and Healthcare Predictors of Adherence to Ferrous Sulfate Supplementation Among Pregnant Women at a Hospital in Lima
Predictores culturales y sanitarios para la adherencia al sulfato ferroso en gestantes de un hospital de Lima
DOI:
https://doi.org/10.22258/hgh.v10i3.388Abstract
Objective: To determine the cultural and healthcare predictors of adherence to ferrous sulfate supplementation among pregnant women. Materials and Methods: An observational study with an explanatory scope and a causal correlational design was conducted. The study included 180 pregnant women receiving care at outpatient clinics of Hospital San Juan de Lurigancho between September and November 2024, selected using simple random probability sampling. The dependent variable was adherence to ferrous sulfate supplementation, while the independent variables included cultural and healthcare predictors. Associations between variables were assessed using the chi-square test or Fisher’s exact test, with p<0.05 considered statistically significant. Significant variables were included in an ordinal logistic regression model to estimate their combined effects, reported as odds ratios (ORs) with 95% confidence intervals (95%CI). Results: Cultural predictors of low adherence to ferrous sulfate supplementation included alcohol and drug use (OR: 8.06; 95% CI: 6.68–9.73; p<0.001), forgetting to take medication (OR: 7.793; 95% CI: 6.45–9.41; p<0.001), and lack of family support (OR: 5.44; 95% CI: 4.79–6.17; p<0.001). Healthcare predictors included previous use of ferrous sulfate (OR: 8.63; 95% CI: 6.16–12.09; p<0.001), discomfort when taking ferrous sulfate (OR: 6.14; 95% CI: 5.21–7.23; p<0.001), and counseling regarding ferrous sulfate supplementation (OR: 5.24; 95% CI: 4.69–5.86; p<0.001). Conclusions: Cultural and healthcare predictors of adherence to ferrous sulfate supplementation among pregnant women included alcohol and drug use, forgetting to take medication, family support for treatment, previous iron supplementation, discomfort when taking ferrous sulfate, and counseling regarding ferrous sulfate supplementation. The implementation of an educational program for pregnant women across all trimesters, providing clear guidance on the appropriate administration of ferrous sulfate, is recommended. Keywords: Medication Adherence; Ferrous Sulfate; Pregnancy; Anemia; Peru (Source: MeSH, NLM).Downloads
References
Garro V, Thuel M. Anemia por deficiencia de hierro en el embarazo, una visión general del tratamiento. Revista Médica Sinergia. 2020; 5(3). DOI: 10.31434/rms.v5i3.397.
Organización Mundial de la Salud. Anemia. Ginebra: OMS; 2025. https://www.who.int/news-room/fact-sheets/detail/anaemia
Ministerio de Salud. Norma técnica – Manejo terapéutico y preventivo de la anemia en niños, adolescentes, mujeres gestantes y puérperas. Perú: Ministerio de Salud; 2017. http://bvs.minsa.gob.pe/local/MINSA/4190.pdf
Organización Mundial de la Salud. Adherencia a los Tratamientos a Largo Plazo. Pruebas para la acción. Ginebra: Organización Mundial de la Salud; 2004. https://iris.paho.org/bitstream/handle/10665.2/41182/adherencia-largo-plazo.pdf?sequence=1&isAllowed=y
King SE, Yeh PT, Rhee DK, Tuncalp Ö, Rogers LM, Narasimhan M. Self-management of iron and folic acid supplementation during pre-pregnancy, pregnancy and postnatal periods: a systematic review. BMJ Glob Health. 2021 May;6(5):e005531. DOI: 10.1136/bmjgh-2021-005531.
Gomes F, King SE, Dallmann D, Golan J, da Silva ACF, Hurley KM, Bergeron G, Bourassa MW, Mehta S. Interventions to increase adherence to micronutrient supplementation during pregnancy: a systematic review. Ann N Y Acad Sci. 2021;1493(1):41-58. DOI: 10.1111/nyas.14545.
Engidaw MT, Lee P, Fekadu G, Mondal P, Ahmed F. Effect of Nutrition Education During Pregnancy on Iron-Folic Acid Supplementation Compliance and Anemia in Low- and Middle-Income Countries: A Systematic Review and Meta-analysis. Nutr Rev. 2025; 83(7):e1472-e1487. DOI: 10.1093/nutrit/nuae170.
Santander Ballestín S, Giménez Campos MI, Ballestín Ballestín J, Luesma Bartolomé MJ. Is Supplementation with Micronutrients Still Necessary during Pregnancy? A Review. Nutrients. 2021; 13(9):3134. DOI: 10.3390/nu13093134.
Duarte AFM, Carneiro ACSV, Peixoto ATBMM, Montenegro DFP, Campos DSC, Alves APR, Costa ARMM, Fino APM. Oral Iron Supplementation in Pregnancy: Current Recommendations and Evidence-Based Medicine. Rev Bras Ginecol Obstet. 2021;43(10):782-788. DOI: 10.1055/s-0041-1736144.
De la Guardia M, Ruvalcaba J. La salud y sus determinantes, promoción de la salud y educación sanitaria. JONNPR. 2020; 5(1). DOI: 10.19230/jonnpr.3215.
Ortiz Y, Ortiz K, Castro B, Nuñez S, Rengifo G. Factores sociodemográficos y prenatales asociados a la anemia en gestantes peruanas. Revista electrónica trimestral de Enfermería. 2019 (56): 273-281. DOI: 10.6018/eglobal.18.4.358801.
Paredes I, Choque L, Linares A. Factores asociados a los niveles de anemia en gestantes del hospital Hipólito Unanue, Tacna 2016. Revista Médica Basadrina. 2018; 12(1): 28-34. DOI: 10.33326/26176068.2018.1.630.
Macías R. Factores culturales y desarrollo cultural comunitario. Reflexiones desde la práctica. Enciclopedia virtual Eumed.net. 2011. https://www.eumed.net/libros-gratis/2011c/985/factores%20culturales%20y%20desarollo%20cultural.html
Duque M. Cultura y salud: elementos para el estudio de la diversidad y las inequidades. Investigación en Enfermería: Imagen y Desarrollo. 2007; 9(2): 127-142. https://www.redalyc.org/pdf/1452/145212857004.pdf
Garg R, Bala J, Garg, P, Subashini S, Jasline M, Vedamurthy R, et al. Cultural determinants in anemia prevention and management: Insights from women and caregivers. Indian Journal of Obstetrics and Gynecology Research 2024;11(3):308–314. DOI: 10.18231/j.ijogr.2024.060.
Pitigala K. Cultural factors associated with iron deficiency anaemia in pregnancy: a case study of the kalutara district, Sri Lanka. Proceeding of the 2nd Global Public Health Conference. 2019; 2: 62-65. DOI: 10.17501/26138417.2019.2107.
Sedlander E, Long MW, Mohanty S, Munjral A, Bingenheimer JB, Yilma H, Rimal RN. Moving beyond individual barriers and identifying multi-level strategies to reduce anemia in Odisha India. BMC Public Health. 2020; 20(1):457. DOI: 10.1186/s12889-020-08574-z.
Tskhay A, Moldakozhayev A, Morais A. A Scoping Review of Iron Supplementation Programs During Pregnancy: Insights from Global Implementation Strategies. The Annals of Family Medicine September 2025, 23 (Supplement 1) 7854. DOI: 10.1370/afm.23.s1.7854.
Herlina J, Yunitasari E, Rumambo M. Impact of Culture-Bases Family Empowerment on Anemia Prevention Behavior in Pregnant Women: A Systematic Review. 2025. DOI: 10.1101/2025.09.10.25335498.
Segura A. El sistema sanitario, la atención primaria y la salud pública. Atención Primaria. 2018; 50(7): 388-389. DOI: 10.1016/j.aprim.2018.01.001.
Desta M, Kassie B, Chanie H, Mulugeta H, Yirga T, Temesgen H, Leshargie CT, Merkeb Y. Adherence of iron and folic acid supplementation and determinants among pregnant women in Ethiopia: a systematic review and meta-analysis. Reprod Health. 2019; 16(1):182. DOI: 10.1186/s12978-019-0848-9.
Sendeku FW, Azeze GG, Fenta SL. Adherence to iron-folic acid supplementation among pregnant women in Ethiopia: a systematic review and meta-analysis. BMC Pregnancy Childbirth. 2020; 20(1):138. DOI: 10.1186/s12884-020-2835-0.
Dutta RR, Chhabra P, Kumar T, Joshi A. Tackling Anemia in Pregnant Women in India: Reviewing the Obstacles and Charting a Path Forward. Cureus. 2023; 15(8):e43123. DOI: 10.7759/cureus.43123.
Mekonen E, Alemu S. Determinant factors of poor adherence to iron supplementation among pregnant women in Ethiopia: A large population-based study. Heliyon. 2021; 7(7): e07530. DOI: 10.1016/j.heliyon.2021.e07530.
Fouelifack F, Sama J, Sone C. Assessment of adherence to iron supplementation among pregnant women in the Yaounde gynaeco-obstetric and paediatric hospital. Pan Afr Med J. 2019; 34: 211. DOI: 10.11604/pamj.2019.34.211.16446.
Godoy E. Factores relacionados con la adherencia al sulfato ferroso en gestantes de los establecimientos de salud de la Micro Red Cono Sur de la Región de Salud de Tacna. Revista Médica Basadrina. 2020; 14(01): 17-26. DOI: 10.33326/26176068.2020.1.921.
Ratnaprabha G, Shilpa R, Mary A., Maria J, Mathew R., Johnson A, et al. Barriers to Adherence to Iron Supplements in Pregnancy in Rural South India. RGUHS National Journal of Public Health. 2018; 3(4): 17-24.
Abal Y, Reynaga M. Factores influyentes en la adherencia de suplementación con sulfato ferroso en gestantes - Centro de Salud Belenpampa Cusco, noviembre 2018 – Enero 2019. [Tesis]. Perú: Universidad Andina del Cusco; 2019. https://repositorio.uandina.edu.pe/bitstream/handle/20.500.12557/3010/Yuvely_Mervi_Tesis_bachiller_2019.pdf?sequence=1&isAllowed=y
Ali SH, Wolka E, Liben ML. Adherencia a la suplementación con hierro y ácido fólico y factores asociados entre las asistentes de atención prenatal en instituciones de salud pública: El caso del distrito de Borena, Amhara, Etiopía: Estudio transversal. Int. J. Child Health Nutr. 2022;11(1):42-8. DOI: 10.6000/1929-4247.2022.11.01.5.
Conga L. Factores relacionados con la adherencia a la suplementación con sulfato ferroso más ácido fólico en gestantes de los establecimientos de la micro red Belén, Red Huamanga, Ayacucho, 2021. [Tesis de Maestría]. Perú: Universidad Nacional de San Cristóbal de Huamanga; 2021. http://repositorio.unsch.edu.pe/xmlui/bitstream/handle/UNSCH/5344/TM%20SP64_Con.pdf?sequence=1&isAllowed=y
Inca V, Munares O. Factores asociados a la adherencia a suplementos de hierro en gestantes atendidas en un centro de salud de Cañete, Perú. Revista Internacional Salud Materno Fetal. 2020; 5(1): 3-10. http://ojs.revistamaternofetal.com/index.php/RISMF/article/view/149
Velez E, Menacho R, Diaz C. Factores relacionados a la adherencia del sulfato ferroso en gestante del Centro de Salud Monterrey, Huaraz 2022. Llalliq. 2024; 4(1): 209-225. DOI: 10.32911/llalliq.2024.v4.n1.1128.
Alfaro K. Factores que influyen a la adherencia del tratamiento profiláctico con sulfato ferroso en gestantes atendidas en el Puesto de Salud de Cruz Blanca, 2021. [Tesis]. Chincha-Perú: universidad de Autónoma de Ica; 2023. https://repositorio.autonomadeica.edu.pe/bitstream/20.500.14441/2253/1/ALFARO%20RONDAN%20KAREN%20STEFHANI.pdf
Baltazar Y, Damian L. Factores asociados a la adherencia de sulfato ferroso en gestantes del Centro de Salud Llata, 2022 – 2023. [Tesis]. Huánuco-Perú: Universidad Nacional Hermilio Valdizán. Facultad de Obstetricia; 2023. https://repositorio.unheval.edu.pe/backend/api/core/bitstreams/86a2051f-7dbb-4c6d-b838-307ac7d46802/content
Merino V, Lozano D, Torrico F. Factores que influyen la adherencia a la suplementación con sulfato ferroso durante el embarazo. Gaceta Médica Boliviana. 2010; 33(2). https://www.gacetamedicaboliviana.com/index.php/gmb/article/view/458/364
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