Awareness, knowledge and the factors that affect the use of folic acid among pregnant and non-pregnant women in the reproductive age in a selected area in Colombo district, Sri Lanka

Abstract

Background: The prevalence of neural tube defects in Sri Lanka is estimated to be 1.21 per 1000 births. According to the WHO, programs to increase folic acid (FA) consumption among women of reproductive age may benefit countries where the NTD rate is higher than 0.6/1,000 live births. Food fortification is an effective method but there is still no mandatory fortification policy in Sri Lanka. Therefore, improving knowledge and voluntary use of FA remains a high priority. The study aimed to determine the awareness and knowledge on FA among pregnant and non pregnant women. Methods: A comparative cross-sectional study was conducted among 400 pregnant and 400 non-pregnant women aged 18-45 years from Colombo District in Sri Lanka. Data were collected using an anonymous, standardized, intervieweradministered questionnaire, which included questions about socio-demographic data, obstetric history, FA knowledge and use. Results: FA awareness and knowledge on its pre-conceptional use were significantly low among non-pregnant women younger than 25 years (OR=0.120, 95% CI=0.068-0.211, p=0.000; OR=0.153, 95% CI=0.090-0.262, p=0.000). Pregnant women with knowledge that FA prevents birth defects were significantly more likely to take FA during pregnancy (OR=10.760, 95% CI=1.244-93.068, p=0.007) and the pre-conceptional period (OR=1.807, 95% CI=1.172-2.786, p=0.007). Women who received information from field clinics were significantly more likely to have FA awareness (OR=4.779, 95% CI=0.913-25.021, p=0.042), knowledge on pre-conceptional use of FA (OR=2.972, 95% CI=1.179-7.491, p=0.016) and took FA during pregnancy (OR=39.773, 95% CI=4.542-348.271, p=0.000). Those who received information from home visits were significantly more likely to have knowledge on the role of FA in preventing birth defects (OR=1.958, 95% CI=1.133-3.384, p=0.015), took FA during their pregnancy (OR=15.102, 95% CI=1.743-130.841, p=0.001) and in the pre-conceptional period (OR=2.117, 95% CI=1.316-3.405, p=0.002). Women who got information through media were also significantly more likely to have knowledge on the role of FA in preventing birth defects. (OR=2.487, 95% CI=1.006-6.149, p=0.042). Conclusions: Health education campaigns have to be specifically targeted for younger women from ethnic minorities and from low household income families. Field clinics and home visits from public health midwives have been a significant sources of information and media campaigns can be an effective means of promoting health education regarding use of preconceptional folic acid.