1
|
Felipe-Dimog EB, Yu CH, Ho CH, Liang FW. Factors Influencing the Compliance of Pregnant Women with Iron and Folic Acid Supplementation in the Philippines: 2017 Philippine Demographic and Health Survey Analysis. Nutrients 2021; 13:nu13093060. [PMID: 34578937 PMCID: PMC8468511 DOI: 10.3390/nu13093060] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Revised: 08/28/2021] [Accepted: 08/30/2021] [Indexed: 11/16/2022] Open
Abstract
Anemia in pregnancy, which is a public health concern for most developing countries, is predominantly caused by iron deficiency. At least, 180 days of iron and folic acid (IFA) supplementation is recommended for pregnant women to mitigate anemia and its adverse effects. This study aimed to examine compliance with the recommendation of IFA supplementation and its underlying factors using the 2017 Philippine National Demographic and Health Survey data. The variables assessed included age, highest level of education, occupation, wealth index, ethnicity, religion, residence, number of pregnancies, time of first antenatal care (ANC) visit and number of ANC visits. Compliance with the recommendation of at least 180 days of IFA supplementation was the outcome variable. The study assessed 7983 women aged 15-49 years with a history of pregnancy. Of these participants, 25.8% complied with the IFA supplementation recommendation. Multiple logistic regression analysis showed that pregnant women of Islamic faith and non-Indigenous Muslim ethnicity were less likely to comply with the IFA supplementation recommendation. Being aged between 25 and 34 years, having better education and higher wealth status, rural residency, initiating ANC visits during the first trimester of pregnancy and having at least four ANC visits positively influenced compliance with IFA supplementation. The effect of residence on IFA adherence differed across the wealth classes. Strategies targeted at specific groups, such as religious minorities, poor urban residents, the less educated and young women, should be strengthened to encourage early and regular antenatal care visits for improving compliance.
Collapse
Affiliation(s)
- Eva Belingon Felipe-Dimog
- Department of Public Health, College of Health Sciences, Kaohsiung Medical University, No. 100, Shih-Chuan 1st Road, Sanmin District, Kaohsiung 807, Taiwan;
- Department of Nursing, Mountain Province State Polytechnic College, Bontoc 2616, Mountain Province, Philippines
| | - Chia-Hung Yu
- Department of Anesthesiology, Chi Mei Medical Center, No 901, Zhonghua Road, Yongkang District, Tainan City 710, Taiwan;
| | - Chung-Han Ho
- Department of Medical Research, Chi Mei Medical Center, No 901, Zhonghua Road, Yongkang District, Tainan City 710, Taiwan;
| | - Fu-Wen Liang
- Department of Public Health, College of Health Sciences, Kaohsiung Medical University, No. 100, Shih-Chuan 1st Road, Sanmin District, Kaohsiung 807, Taiwan;
- Department of Medical Research, Kaohsiung Medical University Hospital, No.100, Tzyou 1st Road, Sanmin District, Kaohsiung 807, Taiwan
- Correspondence: ; Tel.: +886-7-312-1101 (ext. 2786)
| |
Collapse
|
2
|
Paudyal N, Parajuli KR, Garcia Larsen V, Adhikari RK, Devkota MD, Rijal S, Chitekwe S, Torlesse H. A review of the maternal iron and folic acid supplementation programme in Nepal: Achievements and challenges. MATERNAL AND CHILD NUTRITION 2021; 18 Suppl 1:e13173. [PMID: 33763980 PMCID: PMC8770647 DOI: 10.1111/mcn.13173] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 10/19/2020] [Accepted: 01/27/2021] [Indexed: 12/04/2022]
Abstract
In the late 1990s, an estimated 75% of pregnant women in Nepal were anaemic. Although iron and folic acid (IFA) supplements were available free of charge, coverage among pregnant women was very low. In response, the Government of Nepal launched the Iron Intensification Programme (IIP) in 2003 to improve the coverage of IFA supplementation and anthelminthic treatment during pregnancy, as well as promote the utilization of antenatal care. This review examined how the IIP programme contributed to Nepal's success in increasing the consumption of IFA supplements during pregnancy. Nepal's cadre of Female Community Health Volunteers were engaged in the IIP to support the community‐based distribution of IFA supplements to pregnant women and complement IFA distribution through health facilities and outreach services. As a result, the country achieved a fourfold increase in the proportion of women who took IFA supplements during pregnancy between 2001 and 2016 (from 23% to 91%) and a 12‐fold increase in the proportion who took IFA supplements for at least 90 days during pregnancy (from 6% to 71%). The increase in coverage of IFA supplements accompanied an increase in the coverage of antenatal care during the same period. By 2016, the prevalence of anaemia in pregnant women decreased to 46%, highlighting the need to tackle other causes of anaemia and improve haemoglobin concentration before pregnancy, while maintaining the successful efforts to reach pregnant women with IFA supplements at the community level.
Collapse
Affiliation(s)
- Naveen Paudyal
- Nutrition Section, United Nations Children's Fund (UNICEF), Kathmandu, Nepal
| | - Kedar Raj Parajuli
- Department of Health Services, Nepal Ministry of Health and Population, Kathmandu, Nepal
| | - Vanessa Garcia Larsen
- International Health Department, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | | | - Sanjay Rijal
- Nutrition Section, United Nations Children's Fund (UNICEF), Kathmandu, Nepal
| | - Stanley Chitekwe
- Nutrition Section, United Nations Children's Fund (UNICEF), Kathmandu, Nepal
| | - Harriet Torlesse
- Nutrition Section, United Nations Children's Fund (UNICEF), Regional Office for South Asia, Kathmandu, Nepal
| |
Collapse
|
3
|
Barker M, D'Angelo S, Ntani G, Lawrence W, Baird J, Jarman M, Vogel C, Inskip H, Cooper C, Harvey NC. The relationship between maternal self-efficacy, compliance and outcome in a trial of vitamin D supplementation in pregnancy. Osteoporos Int 2017; 28:77-84. [PMID: 27549309 PMCID: PMC5404713 DOI: 10.1007/s00198-016-3721-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Accepted: 07/21/2016] [Indexed: 10/21/2022]
Abstract
UNLABELLED In a randomised controlled trial of vitamin D during pregnancy, we demonstrated that women with lower self-efficacy were more likely to experience practical problems with taking the trial medication and that this was associated with lower compliance and achieved 25(OH)-vitamin D concentrations. INTRODUCTION The relationship between self-efficacy (the belief that one can carry out a behaviour), compliance with study protocol and outcome was explored within a randomised, double-blind, placebo-controlled trial of vitamin D supplementation in pregnancy. METHODS In the Maternal Vitamin D Osteoporosis Study (MAVIDOS) trial, women with circulating plasma 25(OH)-vitamin D of 25-100 nmol/l in early pregnancy were randomised to either 1000 IU cholecalciferol/day or matched placebo from 14 weeks until delivery. Circulating 25(OH)-vitamin D concentrations were assessed at 14 and 34 weeks' gestation. A sequential sub-sample completed Schwarzer's General Self-Efficacy Scale at 14 and 34 weeks and the Problematic Experiences of Therapy Scale at 34 weeks. Women were interviewed about their experiences of the trial and interview transcripts analysed thematically. RESULTS In 203 women, those with higher self-efficacy were less likely to experience practical problems taking the study medication (odds ratio (OR) 0.81 (95 % confidence interval (CI) 0.69-0.95), p = 0.01). Over half reported practical problems associated with poorer compliance with the protocol requiring women to take the medication daily. Compliance in women who experienced practical problems was 94 % compared with 98 % for those with no problems (p < 0.001). Poorer compliance was also associated with lower concentrations of 25(OH)-D in late pregnancy in the treatment group (β = 0.54 nmol/l (95 % CI 0.18-0.89), p = 0.003). Thematic analysis suggested common difficulties were remembering to take the medication every day and swallowing the large capsules. CONCLUSIONS These findings suggest that differences in self-efficacy influence trial outcomes. Such information may help clinicians anticipate responses to routine vitamin D supplementation in pregnancy and identify those who may need more support to comply. TRIAL REGISTRATION ISRCTN82927713, registered 11/04/2008.
Collapse
Affiliation(s)
- M Barker
- MRC Lifecourse Epidemiology Unit, Southampton General Hospital, University of Southampton, Southampton, SO16 6YD, UK.
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, University of Southampton, Southampton, UK.
| | - S D'Angelo
- MRC Lifecourse Epidemiology Unit, Southampton General Hospital, University of Southampton, Southampton, SO16 6YD, UK
| | - G Ntani
- MRC Lifecourse Epidemiology Unit, Southampton General Hospital, University of Southampton, Southampton, SO16 6YD, UK
| | - W Lawrence
- MRC Lifecourse Epidemiology Unit, Southampton General Hospital, University of Southampton, Southampton, SO16 6YD, UK
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, University of Southampton, Southampton, UK
| | - J Baird
- MRC Lifecourse Epidemiology Unit, Southampton General Hospital, University of Southampton, Southampton, SO16 6YD, UK
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, University of Southampton, Southampton, UK
| | - M Jarman
- Li Ka Shing Centre for Health Research Innovation, Department of Agriculture, Food and Nutritional Science, University of Alberta, Edmonton, Canada
| | - C Vogel
- MRC Lifecourse Epidemiology Unit, Southampton General Hospital, University of Southampton, Southampton, SO16 6YD, UK
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, University of Southampton, Southampton, UK
| | - H Inskip
- MRC Lifecourse Epidemiology Unit, Southampton General Hospital, University of Southampton, Southampton, SO16 6YD, UK
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, University of Southampton, Southampton, UK
| | - C Cooper
- MRC Lifecourse Epidemiology Unit, Southampton General Hospital, University of Southampton, Southampton, SO16 6YD, UK
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, University of Southampton, Southampton, UK
- NIHR Musculoskeletal Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, The Botnar Research Centre, University of Oxford, Oxford, UK
| | - N C Harvey
- MRC Lifecourse Epidemiology Unit, Southampton General Hospital, University of Southampton, Southampton, SO16 6YD, UK
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, University of Southampton, Southampton, UK
| | | |
Collapse
|