Bijoy Kumar Panda*, Vaishali S Taralekar, Aditya Mishra, Priyanka Srivastava


A prospective cross-sectional study conducted to analyze and improve adherence pattern towards oral iron supplements in pregnancy with interventions. A potential group study for the duration of 6 months was carried in a tertiary care teaching hospital. 100 pregnant subjects were randomly assigned in to control and intervention group. Control group received prescription to purchase iron supplements while intervention group was dispensed with free oral iron supplements at each OPD visit. Both the groups were subjected to counseling at each visit. Hemoglobin level adherence was assessed using Morisky 8 item Medication Adherence Scale (MMAS-8) to monitor progress. The study observed significantly higher prevalence of anemia among pregnant women in low educated section, low economic status and increasing gravidity in both the groups. The mean adherence rate and hemoglobin levels were significantly high in intervention group at fourth visit. Forgetfulness and side effects associated to iron therapy were the most common reasons for non-adherence in both the groups. Free iron supplements along with routine counseling by pharmacist on follow up radically improved the adherence status to the medication thereby improve hemoglobin pregnant women. Lower education, economic status and high gravidity were responsible for higher incidence of anemia in such population.


Adherence, Iron deficiency anemia, Iron supplementation, Morisky Medication Adherence Scale, Pregnancy.

Full Text:

Full text in pdf


Abou-Zahr C. (1990) Non-compliance: A major problem

in anaemia control . EDM; 10: 16-17.

ACC/SCN. (1991) Controlling iron deficiency. A report

based on an ACC/SCN workshop, State-of-the-artseries.

Nutrition policy discussion paper no. 9, p.4.

Agarwal T., Kochar G.K. and Goel S. (2008) Impact of

Iron Supplementation on Anemia during Pregnancy. J

Ethnobiology and Ethnomedicine, 2(2), p.149-151.

All India consumer price index. Available from from: (Accessed

on August 20 , 2012)

Arturo M.C.A.L., Marti G.P., Comunian G. and Munoz S.

(2002). Prevalence of anemia during pregnancy: Results of

Valencia (Venezuela) anemia during pregnancy study.

Archivos Latinoamericanos de Nutricion, 52(1), p.1-13.

Benoist B., McLean E., Egli I. and Cogswell M.

Worldwide prevalence of anaemia 1993-2005. (2008)

WHO global database on anaemia; 2008. Available from

ns/2008/9789241596657_eng.pdf (Accessed on Oct 12,


Breyman C. (2001). Current aspects of diagnosis and

therapy of iron deficiency anemia in pregnancy. Schweiz

Rundsch Med Prax, 90, p.1281-1293

De-Maeyer E.M. (1989). Preventing and controlling Iron

Deficiency Anaemia Through Primary Health Care,

W.H.O publication, p. 26.

Dim C.C. and Onah H.E. (2007). The Prevalence of

Anemia Among Pregnant Women at Booking in Enugu,

South Eastern Nigeria. Medscape Gen Med, 9(3): p.11.

Dutta D.C., (2004): Anaemia in pregnancy. Text book of

Obstetrics including Perinatology & Contraception, 6th

ed., New Central Book Agency, India.

Elder L.K. (2000). Issues in programming for maternal

anaemia. Center for Population, Health and Nutrition.

Bureau for Global Programs, Field Support and Research,

U.S; Sept.

Garn S.M., Keating M.T. and Falkner F. (1981)

Hematologic status and pregnancy outcomes. Am. J. Clin.

Nutr. 34, p.115–7.

Gautam V.P., Bansal Y., Taneja D.K. and Saha R. (2010).

Prevalence of Anemia Amongst Pregnant Women And

Its Socio-Demographic Associates In a Rural Area of

Delhi. Indian J Comm Med., XXVII (4), p.157-160.

Hinderaker S.G., Oslen B.E., Per Bergsjo et al. (2001).

Anemia in Pregnancy in the highlands of Tanzania. Acta

Obstetriciaet Gynecologica Scandinavica, 80, p.18-26.

ICMR, 1989. Task Force Study. Evaluation of the

National Nutritional Anemia Prophylaxis Programme.

New Delhi: Indian Council of Medical Research.

Jin L., Yeung L.F., Cogswell M.E. et al. (2010). Prevalence

of anaemia among pregnant women in South-east China.

Public Health Nutr., 13, p.1511-1518.

Kapil U., Pathak P., Tandon M., Singh C., Pradhan R. and

Dwivedi.S.N. (1999). Micronutrient deficiency disorders

amongst pregnant women in three urban slum

communities of Delhi. Indian Pediat, 36, p.991-998.

Kisioglu N.N. et al. (2004). Anemia prevalence and its

affecting factors in pregnant women of Isparta Province.

Biomedical Research studies, 16(1), p.11-14.

Kulkarni A.P. and Barde J.P. (1998). Text book of

community medicine. 2nd Ed. Mumbai: Vora Medical


Lincetto O. (2002) Iron and folate supplementation.

Integrated Management of Pregnancy and Childbirth

(IMPAC). World Health Organization, Geneva; Oct 14-

Mengi V., Abdul R. and Bhan V.K. (1988). A study of

anemia in Pregnancy, in: Block Ganderbal. IJCM 1988;

(2): p.92-98.

Morisky D., Green L.W. and Levine D.M. (1986).

Concurrent and predictive validity of a self reported

measure of medication adherence. Med Care. 24, p.67-74.

Morisky DE, Ang A, Krousel-Wood M, Ward H.

Predictive validity of a medication adherence measure for

hypertension control. J Clin Hypertens 2008;10: 348–354.

Morrow O. (1990) Iron Supplementation During

Pregnancy: Why aren’t Women Complying? A Review of

Available Literature, World Health Organization, p. 16

NFHS-3 (2006). National Family Health Survey (NFHS-

, 2005-2006, India, Mumbai: Indian Institute of

Population studies.

Panghal R. and Boora P. (2010). Prevalence of anemia

among pregnant women of low income group of Hisar

district of Haryana. J Dairying, Foods and Home Sci., 29(2),


Scholl T.O., Hediger M.L., Fischer R.L. and Shearer J.W.

(1992) Anemia vs iron deficiency: increased risk of

preterm delivery in a prospective study. Am J Clin Nutr.,

, p.985–8.

Tolentino K. and Friedman J.F. (2007). An update on

Anaemia in Less Developed Countries. American Journal

of Tropical Medicine and Hygiene, 77, p. 44-51.

Toteja, G.S., Singh, P., Dhillon, B.S., Saxena,

B.N., Ahmed, F.U., Singh, L.t.R.P., et al. (2006).

Prevalence of anemia among pregnant women and

adolescent girls in 16 districts of India. Food and Nutrition



  • There are currently no refbacks.

Copyright © 2015 BIOPHARM JOURNAL  - ISSN 2454-1397 & Powered by Sona Nfinity