Evaluation of the Effect of Iron-Folic Acid Supplementation Adherence on Birth Outcomes Among Antenatal Attendees in Kogi State

Iron-folic acid (IFA) supplementation during pregnancy reduces the risk of maternal anaemia, preterm birth, and low birth weight, yet adherence to prescribed supplementation in Nigerian antenatal settings is poor and its impact on birth outcomes in Kogi State has not been empirically measured. This prospective cohort study evaluates the effect of IFA supplementation adherence on birth outcomes among antenatal attendees in Kogi State, North Central Nigeria. Three hundred pregnant women recruited at 16 to 20 weeks gestation at Lokoja Specialist Hospital and Anyigba District Hospital were followed to delivery. Adherence was assessed monthly using pill count and self-report, with high adherence defined as 80 percent or more of prescribed doses taken. Haemoglobin at 36 weeks, gestational age at delivery, birth weight, and APGAR scores were primary outcomes. High adherence was achieved by 48 percent of participants. Women with high adherence had significantly higher mean haemoglobin at 36 weeks (11.4 vs 10.1 g/dL, p < 0.001), lower low birth weight rates (12 vs 29 percent, p = 0.002), and lower preterm delivery rates (9 vs 22 percent, p = 0.004). Forgetfulness, tablet side effects, and stock-outs at facilities were the dominant adherence barriers. The study provides quantified evidence of IFA benefit in Kogi State and recommends mHealth reminder systems, taste-masked IFA formulations, and facility stock management protocols to improve supplementation adherence. Keywords: iron-folic acid supplementation, adherence, birth outcomes, Kogi State, anaemia in pregnancy