BACKGROUND Iron and folic acid deficiency anaemia are one of the global public health challenges that pose 1.45% of all disability-adjusted life-years. It is recognized as a cause for an unacceptably high proportion of maternal and perinatal morbidity and mortality. Adherence to iron and folic acid supplementation during the antenatal period is paramount to reduce anaemia and its associated morbidities. Although several studies have been conducted across the country, their reports were inconsistent and inconclusive for intervention. Therefore, this systematic review and meta-analysis were aimed to estimate the pooled national level adherence to iron and folic acid supplementation and its determinants among pregnant women in Ethiopia. METHODS This systematic review and meta-analysis were pursued the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2009 guideline. An extensive search of databases including, PubMed, Google Scholar, and African Journals Online were conducted to access articles. The Newcastle- Ottawa quality assessment tool was used to assess the quality of each study and meta-analysis was conducted using a random-effects model. I2 test and Egger's test were used to assess the heterogeneity and publication bias respectively. The meta-analysis of estimating national level adherence were done using STATA version 11 with 95% CI. RESULTS Twenty studies with a total of 16,818 pregnant women were included in this meta-analysis. The pooled national level iron and folic acid supplementation's adherence were 46.15% (95%CI:34.75,57.55). The highest adherence was observed in Addis Abeba, 60% (95%CI: 55.93, 64.07) followed by Tigray, 58.9% (95% CI: 33.86, 84.03). Women who received supplemental information [OR = 2.34, 95%CI: 1.05, 5.24], who had good knowledge [OR = 2.2, 95%CI: 1.05, 5.24], began the ANC visit before 16 weeks [OR = 2.41, 95%CI: 1.76, 3.29], and had ≥4 ANC visits [OR = 2.59, 95% CI: 1.09, 6.15] were more likely adhere to the supplementation. Fear of side effects (46.4, 95% CI: 30.9 61.8) and forgetfulness (30.7, 95% CI: 17.6, 43.8) were the major barriers of adherence of the supplementations. CONCLUSIONS More than four of nine pregnant women have adhered to the iron and folic acid supplementation. This meta-analysis revealed that receiving supplemental counselling, knowledge of the supplement; early registration and frequent ANC visit were significantly associated with the adherence of the iron and folic acid supplementation. Therefore, provision of strengthened supplemental counselling service, antenatal care services, and improving the knowledge of the supplementation is a crucial strategy to increase the adherence among pregnant women in Ethiopia. Besides, addressing the barriers of the adherence of the supplement mainly counseling or managing of side effects and reducing of forgetfulness to take the tablet through getting family support or male involvement during visit is mandatory.

中文翻译：

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埃塞俄比亚孕妇中铁和叶酸补充剂及其决定因素的依从性：系统评价和荟萃分析。

背景技术铁和叶酸缺乏性贫血是全球公共卫生挑战之一，占所有残疾调整生命年的1.45％。它被认为是导致孕产妇和围产期发病率和死亡率比例过高的原因。在产前坚持补充铁和叶酸对于减少贫血及其相关的发病率至关重要。尽管在全国范围内进行了几项研究，但他们的报告并不一致，也没有决定性的干预措施。因此，这项系统的审查和荟萃分析旨在评估埃塞俄比亚孕妇对铁和叶酸补充剂及其决定因素的国家综合遵守情况。方法采用系统评价和荟萃分析的首选报告项目（PRISMA）2009年指南进行了系统评价和荟萃分析。进行了广泛的数据库搜索，包括PubMed，Google Scholar和《 African Journals Online》以访问文章。使用纽卡斯尔-渥太华质量评估工具评估每项研究的质量，并使用随机效应模型进行荟萃分析。I2检验和Egger检验分别用于评估异质性和发布偏倚。使用STATA 11版和95％CI进行了估算国家级依从性的荟萃分析。结果该荟萃分析纳入了二十项研究，总计16,818名孕妇。汇总的国家级铁和叶酸补充剂的依从性为46.15％（95％CI：34.75,57.55）。在亚的斯亚贝巴观察到最高的依从性，为60％（95％CI：55.93，64.07），其次是Tigray，58.9％（95％CI：33.86，84.03）。接受补充信息[OR = 2.34，95％CI：1.05，5.24]的女性，具有良好的知识[OR = 2.2，95％CI：1.05，5.24]，在16周前开始ANC访视[OR = 2.41，95 ％CI：1.76，3.29]，并且进行了≥4次ANC访视[OR = 2.59，95％CI：1.09，6.15]更有可能坚持补充治疗。害怕副作用（46.4，95％CI：30.9 61.8）和健忘（30.7，95％CI：17.6，43.8）是坚持补充的主要障碍。结论9名孕妇中有超过4名坚持使用铁和叶酸补充剂。这项荟萃分析表明，接受补充咨询，补充知识；早期注册和频繁的ANC访视与铁和叶酸补充剂的坚持密切相关。因此，加强埃塞俄比亚的补充咨询服务，产前护理服务以及提高补充知识是提高埃塞俄比亚孕妇依从性的关键策略。此外，必须通过寻求家人的支持或在拜访期间由男性参与来解决补充剂坚持的障碍，主要是对副作用的咨询或处理以及减少健忘服用药片的障碍。提高对补充剂的了解是提高埃塞俄比亚孕妇依从性的关键策略。此外，必须通过寻求家人的支持或在拜访期间由男性参与来解决补充剂坚持的障碍，主要是对副作用的咨询或处理以及减少健忘服用药片的障碍。提高对补充剂的了解是提高埃塞俄比亚孕妇依从性的关键策略。此外，必须通过寻求家人的支持或在拜访期间由男性参与来解决补充剂坚持的障碍，主要是对副作用的咨询或处理以及减少忘记服用片剂的遗忘。