Factors Associated With Adherence To Iron Supplementation Among Pregnant Women

In Indonesia, the contribution of anemia towards maternal mortality is estimated to reach 10% up to 20%. The effort of the government to overcome anemia focuses on iron supplementation program since 1974, but the prevalence of anemia in pregnant mother still relatively high. The factor is discompliance in taking medicine. This study aimed to analyse the factors that related to the compliance of pregnant mother in taking the iron tablet at the Tegalrejo Community Health Centers, Yogyakarta. This research used mixed methods by using sequential explanatory strategy. The quantitative sample is taking used consecutive sampling technique, which presented 81 pregnant mothers and intensity sampling for qualitative research presented 13 informants. Based on the result of the analysis, the factors which related to the Compliance of pregnant mother in taking iron tablet were knowledge (p=0,000), husband support (p=0,000) and midwife support (p=0,000). The most significant Exp(B) score was the variable of husband support, which was 15.297. It concluded that pregnant mothers who got support from their husbands would be 15.297 times more significant to obey in taking the iron tablet. Based on the interview of the informants showed that both husband and midwife support in taking an iron tablet. The factors related to the Compliance of pregnant mother in taking the iron tablet at clinic government Tegalrejo, Yogyakarta was knowledge, husband and midwife supports. Keyword: Factors, Compliance, Iron Tablet, Pregnant Mother ISSN 2354-7642 (Print), ISSN 2503-1856 (Online) Jurnal Ners dan Kebidanan Indonesia Tersedia online pada: http://ejournal.almaata.ac.id/index.php/JNKI INDONESIAN JOURNAL OF NURSING AND MIDWIFERY


INTRODUCTION
Anemia is a condition where hemoglobin concentration is under the standard limit, which disrupts blood capacity to transport oxygen throughout the body (1). World Health Organization (WHO) predicts that the total number of people experience anemia worldwide becomes very high, and the global anemia prevalence is predicted reaching 30,02% to pregnant women increased to 41,08% (2). The prevalence of pregnant mothers who suffer anemia in Indonesia is predicted, reaching 50% to 63,00% in 2015 (3). High-level knowledge of pregnant mother upon anemia and iron tablet can form positive behaviour toward compliance (6). Support by a health worker, especially midwife is vital to make pregnant mother aware of a healthy pregnancy, which may be changed into pathology if she does not keep her health (7). Bored, nausea, vomit, constipation, which are mentioned by mothers in Bicol, Philippine and Senegal is possible to happen to some pregnant mothers who eat iron (8) . This one of a factor which makes mothers become discompliance to take medicine, here the support of husbands is essential to make their wife's disposed to take medicine regularly (6). Support from various parties is significant, considering that this tablet should be eaten every day in the long-term (7). Triangulation used is a triangulation of data sources through interviews and observations. In solving pregnancy issue, the midwife must behave in a friendly way, right, care for every mother who visits (11). Midwives as female friends must know about the needs during pregnancy, physical and mental support is needed when women in pregnancy, childbirth and even after giving birth (15). Midwives say that the best support should be from the husband. The support of husband has significant contribution in supporting the pregnant mother to a consume iron tablet, their care to remind is needed to remember why medicine needed to be consumed every day (12).

RESULTS AND DISCUSSION
The contribution of the family, especially husband, is significant as a strengthener factor in increasing the Compliance to consumption iron (10). Based on chi-square statistic test with the level of trust 95% (α=0,05%) showed that there was a significant relationship between husband support and the Compliance of pregnant mother to consume iron tablet with p-value 0,000.
Husband support is a vital factor that determines iron supplementation (10). It was supported by the results of qualitative analysis which pregnant women say thatthat the husbands showed their support by reminding the mother to consume the medicine and to search for information needed during pregnancy.
If the husband cares by giving attention and monitoring the consumption of iron every day will increase Compliance (13). It wa supported by the results of qualitative analysis which the husbandsaid that they supported the pregnant mothers to consume the iron tablet where the most frequent support was to remind to consumption. This support is significant to remember that iron tablet must be taken every day in the long-term (9).
Obtained answer at instrumental and reward support was still low. It supported by the answer of the mother informants, who stated that husbands were seldom to prepare drink and tablet to consumption every day and less credit as well. This kind of support is essential to remember taking the tablet at night, carry it when hope to stay at other places and to motivate if laziness and side effect occurred (11). It also supported by midwife informants, where they always recommend the mother to take the iron tablet at night before sleeping to avoid queasily and absorption the iron more optimal. It was in line with the research of Wiradnyani (10), good respond to the side effect will minimize the effect from the Fe tablet. Some studies show that side effect upon the Compliance of mother to consumption the IFA tablet is just little (9).

CONCLUSION AND RECOMMENDATION
Based on the data analysis, the research and explanation of the discussion stated that the respondents who take iron