Effectiveness of Health Education Interventions in Enhancing Iron-Folic Acid Supplement Utilization Among Pregnant Women: Systematic Review and Meta-analysis

Context: During pregnancy, the underutilization of iron-folic acid supplements (IFAS) remains a considerable maternal and child health issue. Hence, health education intervention trials were conducted following the recommendation of the World Health Organization and epidemiological studies to enhance the utilization level of the supplements during pregnancy.

Objective: The objective of this meta-analysis was to evaluate the effectiveness of health education interventions in enhancing IFAS utilization during pregnancy.

Data sources: A thorough search was conducted across PubMed, EMBASE, Scopus, CINAHL, Web of Science, Medline, the Cochrane Library, and Google Scholar from August 28 until October 31, 2023.

Data extraction: This study incorporated randomized and quasi-experimental studies that examined the effectiveness of health education interventions in enhancing IFAS utilization during pregnancy.

Data analysis: Comprehensive Meta-Analysis, version 4, which includes the prediction interval, was used for the analysis.

Results: In this meta-analysis and systematic review, 21 articles comprising 6643 pregnant women from different countries were included. The random-effects model was applied to determine the pooled standardized differences in means (0.786; 95% CI: 0.551, 1.021). The prediction interval shows the range of true standardized differences in means (95% CI: -0.168, 1.740), which indicates the variations in the true effect size of health education interventions in enhancing IFAS utilization during pregnancy.

Conclusion: In addition to pooled effect size, another significant advantage of this meta-analysis is conducting the prediction interval to determine the range of the true effect size, which ranges from -0.168 to 1.740 across the groups of different pregnant women, indicating variability in the effectiveness of the interventions in enhancing IFAS utilization during pregnancy. This might occur because most of the primary studies in this meta-analysis were conducted at healthcare facilities and mostly focused on anemic pregnant women attending antenatal care, which did not control for sociocultural determinants. Therefore, future researchers should consider these limitations.