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Impact of Iron-Deficiency Anaemia Education on Iron Supplement Use among Pregnant Women in Nigeria

Abstract

Iron-deficiency anaemia remains a major public health concern during pregnancy in Nigeria and is associated with maternal fatigue, reduced work capacity, increased susceptibility to infections, preterm birth, low birth weight, and other adverse maternal and neonatal outcomes. Pregnancy increases the body's requirement for iron because of expanded maternal blood volume and the demands of fetal and placental growth. Iron supplementation is an important intervention for preventing and managing iron deficiency and reducing the risk of anaemia during pregnancy. Iron-deficiency anaemia education provides pregnant women with information about the causes, risk factors, signs and consequences of iron deficiency, the importance of iron supplementation, recommended supplementation practices, appropriate timing and administration of supplements, possible side effects, and strategies for improving adherence. Iron supplement use refers to the appropriate uptake and regular use of prescribed or recommended iron-containing supplements during pregnancy. In Nigeria, inadequate knowledge, misconceptions about iron supplements, fear of side effects, forgetfulness, difficulty accessing antenatal services, supplement availability, and limited understanding of the consequences of iron deficiency may affect supplement use among pregnant women. Effective iron-deficiency anaemia education may improve women's knowledge, confidence, and adherence to recommended iron supplementation. Against this background, this study investigates the impact of iron-deficiency anaemia education on iron supplement use among pregnant women in Nigeria. The study is anchored on the Health Belief Model, Social Cognitive Theory, and Knowledge-Attitude-Practice framework. The Health Belief Model explains preventive health behaviour through perceived susceptibility, perceived severity, perceived benefits, perceived barriers, and cues to action, providing a basis for understanding pregnant women's decisions regarding iron supplementation. Social Cognitive Theory emphasizes the interaction between knowledge, self-efficacy, social influences, behavioural capabilities, and environmental conditions in shaping health behaviours. The Knowledge-Attitude-Practice framework provides a basis for examining how improved knowledge and attitudes resulting from anaemia education may influence iron supplement use. Collectively, these theoretical perspectives provide a suitable framework for explaining how iron-deficiency anaemia education may influence iron supplement use among pregnant women in Nigeria. The study will adopt a quantitative quasi-experimental research design. Primary data will be collected from pregnant women attending antenatal care services in selected healthcare facilities in Nigeria using a structured interviewer-administered questionnaire. A multistage sampling technique will be employed to select states, local government areas, healthcare facilities, antenatal clinics, and eligible pregnant women. Where feasible, selected participant groups or healthcare facilities will be assigned to intervention and comparison groups. Pregnant women in the intervention group will receive structured iron-deficiency anaemia education covering causes and risk factors of iron deficiency, signs and consequences of anaemia during pregnancy, maternal and fetal health effects, benefits of iron supplementation, recommended use, timing and administration, possible side effects and their management, dietary sources of iron, and the importance of adherence to antenatal recommendations. Iron supplement use will be assessed using indicators such as initiation of supplementation, frequency of use, adherence to recommended supplementation, duration of use, missed doses, and, where feasible, verification through antenatal records or supplement containers. Descriptive statistics will be used to summarize participants' sociodemographic and obstetric characteristics, anaemia knowledge, exposure to education, and iron supplement use. Inferential statistical techniques, including chi-square tests, paired-sample tests, independent-sample tests, and multiple regression analysis, will be used to determine the impact of iron-deficiency anaemia education on iron supplement use. Appropriate diagnostic tests will also be conducted to assess the reliability of the research instrument, model assumptions, goodness of fit, and robustness of the findings. The study is expected to find that iron-deficiency anaemia education has a significant positive impact on iron supplement use among pregnant women in Nigeria. Pregnant women exposed to structured anaemia education are expected to demonstrate improved knowledge of iron deficiency and greater adherence to recommended iron supplementation. Education may increase awareness of the consequences of untreated iron deficiency, improve understanding of the benefits of supplementation, reduce misconceptions about iron tablets, and encourage women to manage minor side effects appropriately rather than discontinue supplementation. However, education alone may not guarantee consistent supplement use because women may continue to experience barriers such as forgetfulness, unpleasant side effects, limited access to antenatal services, supplement stock-outs, financial difficulties, and inadequate follow-up. Consequently, iron-deficiency anaemia education is expected to be most effective when supported by reliable availability of iron supplements, quality antenatal care, adherence counselling, follow-up systems, and appropriate maternal nutrition services. The study is expected to contribute to the literature on maternal nutrition, iron-deficiency anaemia, antenatal care, iron supplementation, maternal health, and public health in Nigeria by providing empirical evidence on the impact of iron-deficiency anaemia education on iron supplement use among pregnant women. The findings will provide useful information to the Federal Ministry of Health and Social Welfare, National Primary Health Care Development Agency (NPHCDA), state ministries of health, antenatal care providers, primary healthcare facilities, hospitals, nutritionists, midwives, community health workers, development partners, and policymakers regarding strategies for improving maternal iron supplementation. The study will also provide evidence-based recommendations for strengthening anaemia education during antenatal care, improving counselling on iron supplementation, ensuring consistent availability of iron supplements, addressing misconceptions and side effects, strengthening follow-up mechanisms, and promoting appropriate iron supplement use among pregnant women across Nigeria.

Keywords: Iron-deficiency anaemia education, iron supplement use, pregnant women, iron supplementation, maternal nutrition, anaemia prevention, antenatal care, maternal health, nutrition education, health education, public health, Nigeria.