Magnitude and factors associated with iron supplementation among pregnant women in anemia hot spot regions of Ethiopia: Multilevel analysis based on Bayesian approach.

Background: According to World Health Organization, pregnant women should take an oral iron and folic acid every day for at least 3 months to prevent preterm birth, low birth weight, maternal anemia, and puerperal sepsis. In addition to keeping maternal health, it also plays a key role to support the fetus's healthy growth and development. Therefore, it is very important to know the magnitude of iron supplementation and its determinants in anemia hot spot regions of Ethiopia using an appropriate statistical analysis method.

Objective: The aim of this study is to determine the magnitude of iron supplementation and its associated factors in anemia hot spot regions of Ethiopia among pregnant women.

Methods: The study was done using the 2019 Ethiopian Mini Demographic and Health surveys data. Before any statistical analysis was done, the data were weighted using sampling weight for probability sampling and non-response. Then, a total weighted sample of 2116 reproductive age group women in anemia hot spot regions of Ethiopia were used for this study. A multilevel binary logistic regression model based on the Bayesian approach was fitted using the Brms R package to identify the determinants of iron supplementation in anemia hotspot regions of Ethiopia. Finally, the 95% credible interval (CrI) of the adjusted odds ratio (AOR) was used to assess statistical significance. If the interval includes 1, the result is considered non-significant.

Results: This study showed that in anemia hotspot regions of Ethiopia, the overall magnitude of iron supplementation among pregnant women is 55.5% (95% CrI: 53.4%- 57.6%). Being rural resident (AOR = 0.57; 95% CrI 0.34-0.93), having higher education level (AOR = 3.2; 95% CrI 1.80-5.7), having secondary education level (AOR = 3.28; 95% CrI 2.13-5.1), being wealthy (AOR = 1.80; 95% CrI 1.27-2.54), being household headed by female (AOR = 0.55; 95% CrI 0.43-0.71) and, have no children (AOR = 0.4;95%CrI 0.17-0.98) were significantly associated with iron supplementation among pregnant women in anemia hotspot regions of Ethiopia.

Conclusion: The overall magnitude of iron supplementation among pregnant women in anemia hotspot regions of Ethiopia is notably low when compared to the World Health Organization's recommended target. Significant factors associated with higher iron supplementation included having secondary or higher education, rich in wealth, and being from a male-headed household. Conversely, being a rural resident, female-headed household, and having no children were associated with lower iron supplementation.