Factors influencing adherence to iron drop supplementation in infants aged 6 to 24 months: a systematic review of observational studies

Iron deficiency anemia (IDA) is the most common nutritional anemia in the world and a pervasive health problem, especially in developing countries. Children under two years of age are more prone to be affected by IDA. The best strategy to prevent and treat IDA is to use iron supplements. This study aims to examine the factors associated with noncompliance (such as non-utilization or inconsistent usage) of iron drop supplementation among infants between 6 and 24 months old.

Online databases (PubMed, Scopus and SID) were searched to retrieve relevant articles published from inception up to July 2023. Among the 2,177 articles detected, after removing duplicate and irrelevant titles, 21 cross-sectional studies that met the authors’ inclusion criteria were included. Screening for articles and data extraction were conducted separately by two researchers.

The findings suggest that some factors related to mothers, such as education, knowledge, attitude and performance; some factors associated with child such as child’s gastrointestinal and dental complications; taste and smell of iron drops; and birth order and gender are the main determinants of adherence to iron supplementation.

It can be proposed that the most significant factors affecting the feeding of iron drops to children under the age of two include: the level of mother’s awareness, socio-economic status of the household and the occurrence of digestive complications following the supplementation. Given these observations, adopting proper policies toward improving the nutritional awareness of mothers and producing iron supplements with minimal side effects seems crucial.