Iron-folic Acid Research Articles

Perceived Barriers and Enablers for Taking Iron–Folic Acid Supplementation Regularly Among Adolescent Girls in Indonesia: A Pilot Study

Non-compliance with iron and folic acid (IFA) supplementation is a significant contribution to the high prevalence of anemia among adolescent girls in Indonesia. This pilot study aims to explore the perceived barriers and enablers to regular IFA supplement consumption among adolescent girls. Using a qualitative approach, data were collected through focus group discussions (FGDs) conducted in Makassar and Padang City. The FGD involved 32 grade eight and nine students from four junior high schools. In-depth interviews were also conducted with health workers, teachers, and parents to triangulate the findings. A thematic analysis was performed using a social cognitive theory framework. The average age of the informants was 13.6 ± 0.6 years. Despite receiving IFA supplements at school, only 47% of informants reported consuming them regularly. Key barriers to regular supplementation included dislike of the taste and smell, parental prohibition, negative experience consuming IFA supplements, the belief that IFA supplements increase menstrual blood flow and volume, and forgetfulness factors. Enablers include self-awareness of the supplement’s benefits, trust in school-provided supplements, and positive support from parents and peers. The findings highlight that both barriers and enablers play a crucial role in influencing IFA supplementation adherence. Addressing these factors is essential for improving compliance and reducing anemia rates among adolescent girls. Given the small sample size and convenience sampling method, this study serves as a pilot, and further research is needed to validate these findings on a larger scale.

Prevalence of undernutrition and associated factors among adolescent pregnant women in Dolo-Ado town, Somali region, Ethiopia.

Maternal malnutrition, particularly among adolescent pregnant women, is a significant public health issue globally, with far-reaching consequences for both maternal and fetal health. It increases the risk of complications such as stillbirth, low birth weight,preterm birth, uterine bleeding, and other pregnancy-related issues. This study aimed to assess the prevalence of undernutrition and associated factors among adolescent pregnant women (aged < 20years) in the Dolo-Ado town, Somali region, Ethiopia. A cross-sectional study was conducted from January 1-30, 2022, involving 380 pregnant adolescents randomly selected from the Dolo-Ado town. A structured, pretested questionnaire was used to gather data on socio-demographics, maternal nutrition, and obstetric characteristics. Nutritional status was assessed using mid-upper arm circumference (MUAC), with undernutrition defined as MUAC ≤ 22cm. Data were collected via home visits, and the accuracy of anthropometric measurements was standardized through training and pretesting. Descriptive statistics were used for data description, and binary logistic regression was performed to explore the associations between independent and dependent variables. A total of 380 pregnant adolescents participated, achieving a 100% response rate. The mean age of the participants was 17.7 (± 0.78) years. Approximately 32.1% of the participants experienced food insecurity, and only 3% met the minimum dietary diversity score. The prevalence of undernutrition was 21% (79/380), as indicated by a MUAC of < 22cm. The high prevalence of undernutrition among pregnant adolescent women in Dolo-Ado poses a significant public health concern. Key factors associated with undernutrition include maternal education [AOR] of 3.9; 95% Confidence Interval [CI]: 1.9-8.0), rural residence (AOR of 12; 95% CI: 3.5-42.9), low family income (AOR of 2.6; 95% CI: 1.2-5.4), food insecurity (AOR of 6.2; 95% CI: 2.8-13.9), iron-folic acid supplementation (AOR of 3.6; 95% CI: 1.7-7.5), and low dietary diversity intake (AOR of 13.1; 95% CI: 2.2-77.3). Therefore, targeted efforts to address family income, household food insecurity, dietary diversity, and access to iron-folic acid supplementation should be prioritized by both government and non-governmental organizations for pregnant adolescents.

Effect of nutrition education and iron-folic acid supplementation on anemia among pregnant women in Ethiopia: a quasi-experimental study

The aim of this study was to assess the effect of nutrition education and counseling using health belief health model constructs along with iron-folic acid supplementation on hemoglobin level and adherence to IFAs during pregnancy. The study was a three-month quasi-experimental study design in Butajira town, Ethiopia. Community-based nutrition education and counseling sessions using the Health belief model, and IFAS for six weeks were given to the pregnant women. Compliance with iron-folic acid supplementation (IFAS) was assessed using pill counts based on the number of remaining pills in the retained prescribed bottles or strips. End-line data were collected from 97 interventions and 96 control groups of pregnant women after 6 weeks of nutrition education interventions. The analysis of the effect of the intervention was done using difference-in-difference and a generalized estimation equation (GEE) approach. At the end of the nutrition education intervention, there was a significant drop in the proportion of anemia in the intervention group compared to the control group. The prevalence of anemia among the intervention group declined from 27.8% at baseline to 7.2% after intervention. The change in the knowledge score regarding IFAS and maternal adherence to IFAS were significantly higher in the intervention group as compared to the control group (p < 0.001). In this study, the odds of adherence to IFA supplementation were 2.26 (95% CI 1.55 to 3.29) times higher among those who received nutrition education interventions as compared to the control group. Implementation of community-based nutrition education and counseling along with IFAS improved the hemoglobin level and adherence to IFAS among pregnant women. Therefore, there is need to integrate community-based nutrition education approach by using HBM constructs with antenatal IFAS distribution to improve supplementation and hemoglobin level of pregnant women.

Acceptance of multiple micronutrient supplementations (MMS) and iron and folic acid supplement utilisation among pregnant and lactating women in the rural part of Ethiopia, 2022: a cross-sectional study

ObjectiveTo assess the acceptance of multiple micronutrient supplements and current iron and folic acid supplement utilisation among pregnant and lactating women in rural Ethiopia.DesignCommunity-based cross-sectional study using a mixed method.SettingThis...

Compliance With Iron–Folic Acid Supplementation and Iron‐Deficiency Anemia Among Pregnant Women in Kathmandu

Background: Iron‐deficiency anemia (IDA) during pregnancy is a major public health concern, leading to adverse maternal and fetal health outcomes such as premature birth and low birth weight. This study aimed to identify factors associated with compliance with iron–folic acid supplementation (IFAS) and the prevalence of IDA among pregnant.Methods: A cross‐sectional study using face‐to‐face interviews with structured questionnaires was conducted among 270 pregnant women attending a private hospital in Kathmandu, Nepal in 2023. Respondents were selected consecutively. Descriptive analysis was performed for categorical variables. Multivariate logistic regression analysis identified factors associated with compliance and anemia (p &lt; 0.05).Results: Most respondents were young adults (mean age: 30.09 ± 4.40 years) with secondary level education (57.8%) and homemaker occupations (57.4%). Over half (56.3%) demonstrated good knowledge of anemia, and slightly more than half (50.0%) had good knowledge of iron–folic acid (IFA). Compliance with IFAS was 63.0%, while 28.5% of women had IDA. Compliance was positively associated with occupation (adjusted odds ratio (AOR) = 2.6 and 95% confidence interval (CI) = 1.1–6.0), receiving IFA in the 2nd trimester (AOR = 2.2 and 95% CI = 1.1–5.0), and knowledge of IFA (AOR = 2.4 and 95% CI = 1.2–4.8). Higher education level (AOR = 5.1 and 95% CI = 1.7–15.2) and being employed (AOR = 0.3 and 95% CI = 0.1–0.8) were associated with lower IDA prevalence, while a history of medical illness was associated with higher IDA prevalence (AOR = 4.0 and 95% CI = 1.5–10.6).Conclusion: Despite IFA compliance rates within the national coverage range, forgetfulness, side effects, and inadequate counseling remain barriers. The persistence of anemia, even at a slightly lower rate than national data, remains a significant public health concern. Public health interventions are needed to improve IFA adherence, reduce anemia, and optimize maternal and fetal health outcomes in this population.

Experiences, acceptability and barriers to calcium supplementation during pregnancy in Dar es Salaam, Tanzania.

Calcium supplementation in pregnancy is recommended in contexts with low dietary calcium intake to reduce the risk of pre-eclampsia and its complications. The World Health Organisation suggested high-dose calcium supplementation (1500-2000 mg/day), divided into three doses and taken at different times from daily iron-folic supplements. We conducted a mixed methods evaluation study to assess experiences, acceptability and barriers to high-dose calcium supplementation from the perspectives of pregnant women and antenatal health care providers at two public health facilities in Dar es Salaam, Tanzania. Descriptive statistics and thematic analysis were used to characterise acceptability, barriers and overall experiences of using high-dose calcium supplementation. Pregnant women in the cohort were aged 19-41 years, with 32.4% being primiparous. The proportion of pregnant women who liked calcium supplements 'a lot' decreased from 50.2% at the first visit to 31.8% at the last antenatal follow-up visit. Adherence was 71.3% (interquartile range: 50.5%, 89.3%), with only 24.0% of the participants taking 90% or more of the required supplements. Although participants expressed positive attitudes towards using calcium supplements, they also voiced concerns about the large size, side effects, the potential to forget and the burden of taking calcium supplements three times per day. Antenatal health care providers also affirmed the high burden of taking calcium supplements in addition to iron-folic acid supplements. Participants expressed the acceptability of using calcium supplements during pregnancy, but adherence to three doses per day posed challenges to pregnant women. Reducing the number of calcium supplement doses per day may improve adherence.

Exploring Which Public Health Interventions Are More Effective to Reduce Maternal and Child Health Inequalities in South Asia: A Systematic Literature Review

Background: Maternal and child health disparities remain a pressing public health concern in South Asia. This systematic review addresses a critical gap in the literature by evaluating the effectiveness of public health interventions targeting these disparities in Bangladesh, India, and Pakistan. Distinguishing itself from prior studies, this research provides a thorough examination of the combined effects of community-based programs, financial assistance, and nutritional supplementation, offering a fresh and comprehensive perspective on strategies to reduce health inequities in the region. Methods: A systematic review and narrative synthesis were conducted using databases such as PubMed and Medline, covering articles published between 2000 and 2019. The inclusion criteria focused on observational and experimental studies evaluating interventions aimed at improving maternal and child health. The quality of the studies was assessed using the CASP checklists. Results: The review included 19 studies that demonstrated significant reductions in maternal and child health disparities. Key interventions included demand-side financial assistance, community education, and nutritional supplements. For example, Iron Folic Acid (IFA) supplementation, combined with antenatal care and tetanus toxoid vaccination, significantly reduced postnatal and under-5 mortality (OR = 0.66, 95% CI: 0.45–0.98). Another study reported a 30% reduction in the maternal mortality rate (MMR) among targeted populations. Discussion: Integrating mental health support within maternal healthcare is crucial to addressing exacerbated vulnerabilities. Effective public health initiatives—including financial aid, community-based programs, and improved healthcare services—have demonstrated potential in reducing these disparities. Policy recommendations include combining nutritional supplementation with antenatal care, expanding conditional cash transfer schemes, and enhancing mental health services. Conclusion: Community-based and targeted interventions are essential for reducing health disparities. Policies should prioritize integrated care models, targeted subsidies, and enhanced mental health services to achieve sustainable improvements in maternal and child health outcomes.

A pilot study to assess the knowledge, attitude and utilization of Kishori Balika Yojana among adolescent girls (14-18yrs) at rural mahasamund, Chhattisgarh

Adolescent girls face risks including injuries, reproductive and sexual health issues, mental and emotional problems, and abuse. In response, the Government of India launched the Adolescent Girls’ Scheme in 2000 under the Integrated Child Development Scheme, aiming to enhance nutrition, health, and empowerment among adolescent girls.A community-based cross-sectional descriptive study was carried out in rural Mahasamund to evaluate the knowledge, attitudes, utilization of the Kishori Balika Yojana (KBY), and nutritional status of adolescent girls. A convenient sampling technique selected a sample of 35 adolescent girls. Data collection involved a structured knowledge questionnaire (20 items), a Likert scale (18 items), a checklist (7 items), and a nutritional assessment checklist.Among the 35 adolescent girls, 5 (14.2%) were school dropouts, and 16 (45.7%) were undernourished. Most participants (27 or 77.2%) had moderately adequate knowledge, while 7 (20%) had inadequate knowledge. Perception towards KBY services was neutral for 33 (94.2%) and unfavorable for 2 (5.8%). All 35 girls visited the Anganwadi center; 32 (91.4%) utilized supplementary nutrition services, 33 (94.2%) received iron and folic acid tablets, 22 (62.8%) participated in health checkups, and 17 (48.6%) attended health education sessions. Only 2 (5.7%) were aware of life skills education, and none participated in vocational training services. The study found moderately adequate knowledge, neutral perceptions, and good utilization of supplementary nutrition and iron-folic acid supplementation among the girls. However, participation in health checkups, nutrition and health education, life skills education, and vocational training was limited. Educational interventions and modules on KBY services could enhance knowledge, foster favorable perceptions, and improve utilization of KBY services.

Anemia and adherence to weekly iron-folic acid supplementation among adolescent girls in a stunting locus of Ambon City, Indonesia

Anemia and adherence to weekly iron-folic acid supplementation among adolescent girls in a stunting locus of Ambon City, Indonesia

Impact of iron-folic acid supplementation on maternal and neonatal outcomes: A systematic review & meta-analysis.

Background & Aims: Iron-folic acid (IFA) supplementation is widely recommended as both a preventive and therapeutic measure for pregnant women. Despite its widespread use, there is limited research exploring adherence to IFA supplementation during pregnancy and its impact on maternal and neonatal outcomes. This study aims to assess the effectiveness of IFA supplementation in improving pregnancy and neonatal outcomes. Methods: A comprehensive search on PubMed, Google Scholar, EMbase and Trip databases was conducted for relevant studies published up to May 31, 2024. Outcomes measured were preterm birth (PTB), low birth weight (LBW), neonatal mortality, perinatal mortality, small for gestational age (SGA) and stillbirth. Pooled risk ratios (RRs) with 95% confidence intervals (CIs), sensitivity analysis, publication bias, trial sequential analysis and quality assessment of the included studies were performed. Results: Eleven studies involving a total of 42,458 pregnant women who received IFA supplementation and 16,351 women who received folic acid (FA) alone or Control (no supplementation) were included. A significant reduction in overall neonatal mortality (RR = 0.73, 95% CI: 0.61-0.87) as well as in subgroup analyses (IFA vs. control and IFA vs. FA) was observed. However, a decrease in incidence of LBW was noted only in IFA vs. control group (RR = 0.79, 95% CI: 0.69-0.90). No significant association was found for overall LBW (RR = 0.48, 95% CI: 0.08-2.76), PTB (RR = 0.56, 95% CI: 0.09-3.50), perinatal mortality (RR = 0.85, 95% CI: 0.69-1.04), SGA (RR = 0.98, 95% CI: 0.86-1.12) and stillbirth (RR = 0.75, 95% CI: 0.48-1.16) when comparing to IFA vs. control and IFA vs. FA group. Conclusions: Our findings provide strong evidence supporting the effectiveness of IFA supplementation in reducing neonatal mortality and LBW among pregnant women, highlighting its importance in prenatal care.

Effect of Nutrition Education During Pregnancy on Iron-Folic Acid Supplementation Compliance and Anemia in Low- and Middle-Income Countries: A Systematic Review and Meta-analysis.

Stakeholders implement nutrition education to prevent and control anemia during pregnancy. Nutrition education during pregnancy can increase the consumption of iron-folic acid (IFA) supplements and encourage behavioral changes. However, there is no comprehensive meta-analysis to determine the effectiveness of this intervention. This review aimed to determine the effect of nutrition education on IFA supplementation (IFAS) compliance, hemoglobin level change, and prevalence of anemia in low- and middle-income countries. The systematic searches on Ovid Medline, Scopus, Embase (Elsevier), Web of Science, Health and Medical Collection (ProQuest), and Google Scholar were conducted until September 11, 2023. The updated searches were performed on November 16, 2023. In total, 12 436 records were imported to Covidence. Of these, 9109 records were screened by title and abstract. A total of 112 records were evaluated in full, and 53 articles were ultimately included based on eligibility. Fifty-three peer-reviewed research articles met the inclusion criteria, involving 13 475 pregnant women. Those who received nutrition education during pregnancy were 2.80 times more likely to comply with IFAS (odds ratio = 2.80; 95% CI: 2.04, 3.83; I2 = 66.20%). There was an average increase of 0.88 g/dL (Cohen's d = 0.88; 95% CI: 0.63, 1.13; I2 = 96.17%) in hemoglobin levels among women who received nutrition education. A meta-regression analysis revealed that 61.85% (adjusted R2 = 61.85%) of heterogeneity between standardized mean differences was explained by anemia status, intervention duration, and geographic region. Also, pregnant women in the nutrition education group had a 34% (relative risk = 0.66; 95% CI: 0.54, 0.80, I2 = 86.85%) lower risk of anemia compared with the control group. Nutrition education during pregnancy improves compliance with IFAS, increases hemoglobin levels, and reduces the risk of anemia. Therefore, it is crucial to enhance the existing nutrition education program to prevent and control anemia during pregnancy. PROSPERO registration no. CRD42023454241.

Compliance to iron folic acid consumption and factors associated among antenatal care attendant mothers in southern Ethiopia

Iron and folic acid (IFA) consumption is an important strategy for the prevention of birth defects and anemia during pregnancy. In Ethiopia, low proportion of pregnant mothers took an iron tablet for 90 plus days. Therefore, the aim of this study was to assess compliance to IFA consumption and its associated factors among mothers attending antenatal care in Southern Ethiopia, 2021. An institution-based cross-sectional study triangulated with qualitative methods was conducted. The data was collected data from 378 respondents selected by a simple random sampling technique and 21 in-depth interviews were conducted. Epi Data version 3.1 was used to enter data, which was then exported to Statistical Package for the social Science (SPSS) version 21 for further processing and analysis. Bivariable and multivariable logistic regression analyses were carried out to identify the significant association. Variables with a P-value of less than 0.05 were considered significant. The Open code software version 4.03 was used to code and categorize qualitative data, and then thematic analysis was employed to qualitative data. The compliance rate of IFA consumption was 66.58% 95% CI: 61.5-71.4%) Maternal education (AOR: 3.01, 95%CI:1.29, 6.35), knowledge about anemia (AOR: 2.63, 95% CI:1.29), 5.37), knowledge about IFA (AOR: 2.95, 95% CI (1.45, 6.02)), ANC visits (AOR: 2.70, 95% CI 1.17, 6.22), fear of side effect (AOR: 0.08, 95% CI:0.02, 0.24), registration time for initiation of ANC visits (AOR:4.63, 95% CI:1.50, 14.26), and counseling on IFA (AOR:3.95, 95% CI:1.57, 9.98) were significantly associated with compliance IFA consumption of the pregnant mothers. Supplement-related, pregnancy and experience-related, facility related, behavioral -related, perceived family support, and perceived cultural belief findings were identified from qualitative study. In this study, the compliance with IFA consumption was low and influenced by huge range factors. To improve compliance with IFA, health workers provide proper counseling and education for pregnant women on IFA and follow up supplementation.

Social determinants and socioeconomic inequalities in adherence to antenatal iron-folic acid supplementation in urban and rural Indonesia.

Adherence to iron-folic acid supplementation (IFAS) has been linked with maternal anaemia. While findings about determinants of IFAS adherence have been mixed across different research, there is inadequate evidence in relation to socioeconomic inequalities. This study aims to examine social determinants and socioeconomic inequalities of adherence to IFAS in urban and rural Indonesia. We conducted a secondary analysis of the 2017 Indonesia Demographic and Health Survey by including a total of 12 455 women aged 15-49 years. The outcome was adherence to IFAS for at least 90 days. We used multiple logistic regression analysis adjusted for the survey design to analyse factors associated with IFAS adherence. We estimated socioeconomic inequalities using the Wagstaff normalized concentration index and plotted them using the concentration curve. About half of women consumed IFAS for at least 90 days, with a higher proportion in urban areas (59.0%) than in rural areas (47.8%). Social determinants of adherence to IFAS were similar for urban and rural women. Overall, being an older woman, having weekly internet access, antenatal care for at least four visits, and residing in Java and Bali were significantly linked to IFAS adherence. Higher maternal education was significantly linked to IFAS adherence in urban settings, but not in rural settings. There were interactions between place of residence and woman's education (p<0.001) and household wealth (p<0.001). Concentration indices by woman's education and household wealth were 0.102 (p<0.001) and 0.133 (p<0.001), respectively, indicating pro-educated and pro-rich inequalities. However, no significant education-related disparity was found among rural women (p=0.126). Women (age, education, occupation, birth number, internet access, involvement in decision-making), household (husband's education, household wealth), health care (antenatal care visit) and community (place of residence, geographic region) factors are associated with overall adherence to IFAS. These factors influence the adherence to IFAS in a complex web of deep-seated socioeconomic inequalities. Thus, programs and interventions to improve adherence to IFAS should target women of reproductive age and their families, particularly those from socioeconomically disadvantaged groups residing in rural areas.

Impact of a virtual antenatal intervention for improved diet and iron intake in Kapilvastu district, Nepal - the VALID randomized controlled trial.

Counseling, together with iron and folic acid supplements, can improve hemoglobin levels in pregnant women, but few interventions have tested a virtual method of delivering counseling. We hypothesized that a virtual counseling intervention delivered via a mobile device (mHealth) would prevent and treat anemia, compared with routine antenatal care (ANC). Virtual antenatal intervention for improved diet and iron intake (VALID) was a non-blinded parallel group two-arm, individually randomized superiority trial (1:1 allocation). Participants were pregnant women who were married, aged 13-49 years, able to answer questions, 12-28 weeks' gestation and living in Kapilvastu district, Nepal. Women were randomized to receive routine ANC (control arm), or ANC plus a virtual antenatal intervention of two problem-solving counseling sessions via video call. The primary outcome was iron folic acid (IFA) tablet compliance (consumption on 12 or more days of the previous 14 days). Secondary outcomes were dietary diversity, promoted food consumption, iron bioavailability enhancement, and knowledge of iron-rich foods. Primary logistic regression analysis was by intention-to-treat, adjusting for baseline values. We enrolled 319 pregnant women (161 control, 158 intervention) from 23 January 2022 to 6 May 2022 and analyzed outcomes in 144 control and 127 intervention women. Compliance with IFA increased in both arms. In the intervention arm, compliance increased by 29.7 percentage points (pp) (49.0-78.7%) and 19.8 pp. in the control arm (53.8-73.6%). Despite the more significant increase in the intervention arm, we found no intervention effect upon IFA compliance (adjusted odds ratio [aOR] 1.33; 95% confidence interval [CI]: 0.75, 2.35; p = 0.334), dietary diversity, or ANC visits. The intervention increased knowledge of iron-rich foods (coefficient 0.96; 95% CI: 0.50, 1.41; p < 0.001), consumption of promoted foods (aOR: 1.81; 95% CI: 1.08, 3.02; p = 0.023), behavior to enhance iron bioavailability (aOR: 4.41; 95% CI: 1.23, 15.83; p = 0.023), and coronavirus disease 2019 (COVID-19) knowledge (aOR: 4.06; 95% CI: 1.56, 10.54; p = 0.004). The total intervention cost was US$35,193, and the cost per pregnant woman receiving two virtual counseling sessions was US$277. Virtual counseling can improve antenatal health behaviors, such as the consumption of promoted foods and methods to enhance bioavailability. Improved IFA consumption and ANC attendance may require additional family/community support. https://www.isrctn.com/ISRCTN17842200, identifier ISRCTN17842200.

Postpartum morbidity and its determinants with special reference to anemia among urban vulnerable population in Uttar Pradesh: A cross-sectional study.

The postpartum period is critically important for comprehensive obstetric care; however, most women are neglected during this important period. This study was carried out to determine the burden of postpartum morbidities and associated factors among the urban vulnerable population in Gautam Buddha district, Uttar Pradesh. A cross-sectional study was conducted among 150 postpartum women in urban slums of Gautam Buddha district. A semi-structured questionnaire was used along with a physical examination and assessment of anemia by Sahli's hemoglobinometer. A total of 106 (70.7%) mothers reported at least one of the postpartum morbidities (PPMs). The most frequently reported morbidity was anemia (55.3%) followed by backache (29.3%). Almost a third (39, 36.8%) of all women, who suffered from PPM, did not seek any treatment for the same. Univariate analysis revealed that morbidities were higher among women with low literacy (Odds Ratio, OR: 5.63, 95% CI: 2.508-13.54, p = 0.000), low socioeconomic status (OR: 0.317, 95% CI: 0.151-0.657, p = 0.002), and inadequate antenatal care (OR: 0.108, 95% CI: 0.044-0.246, p = 0.0001). Similarly, young mothers (OR: 2.599, 95% CI: 1.332-5.14), less educated (OR = 3.603, 95% CI: 1.838-7.203, p = 0.000), those from lower economic status (OR: 0.247, 95% CI: 0.119-0.497, p = 0.001), with inadequate antenatal care (OR: 0.112, 95% CI: 0.052-0.232, p = 0.005), and low iron folic acid intake (OR: 0.371, 95% CI: 0.184-0.732, p = 0.004) showed higher prevalence of anemia. The role of education and adequate antenatal care are highlighted in the study. Antenatal visits should be utilized as opportunities to increase awareness regarding various aspects of care during the postnatal period. Maintaining more comprehensive support and involvement between health care providers and the mothers is needed to prevent many of these postpartum morbidities.

Burden and causes of anemia in Vietnam: insights from the global burden of disease data

BackgroundAnemia is a significant global health issue, impacting 1.92 billion people and ranking as a leading cause of disability. It is marked by low hemoglobin levels, which hinder oxygen delivery to vital organs and result from causes such as nutritional deficiencies and chronic diseases. Despite some progress, anemia remains a major concern in Southeast Asia, including Vietnam. Although the country has reduced its anemia rates, the progress is insufficient to achieve the WHO’s 2030 targets for anemia reduction among women of reproductive age. This study explores anemia trends and socio-economic determinants in Vietnam, with a focus on age and gender differences, to inform targeted interventions and policy development.MethodsThis study used the Global Burden of Diseases, Injuries, and Risk Factors (GBD) dataset to explore the burden of anemia and its causes in Vietnam from 1990 to 2021. The GBD study provides data on anemia prevalence and years lived with disability (YLD) by age, sex, and 37 causes across 204 countries and territories. Further, this study employed a regression model to examine how the anemia burden (i.e., prevalence rate and YLD rate) relates to socio-economic factors such as the Human Development Index (HDI), gender disparities in human development achievement, and gender-based inequalities in reproductive health, empowerment, and economic status in Vietnam over this period.ResultsIn 1990, there were 16.30 million anemia cases in Vietnam, decreasing slightly to 16.05 million by 2021. Male prevalence dropped from 34.90 to 26.58%, while female prevalence increased from 65.10 to 73.42%. Iron deficiency was the main cause, affecting 68.35% of cases in 1990 and 68.84% in 2021, with 24.96% in males and 75.04% in females in 2021. While anemia has decreased among infants, young children, and adolescents due to improved healthcare, it has increased among middle-aged and older adults, especially females. Regression analysis shows that higher human development and gender equality reduce anemia prevalence and disability, whereas gender inequality worsens the issue.ConclusionsThe study underscores that anemia remains a major health concern in Vietnam, marked by significant gender and age disparities. Despite a decrease in overall anemia rates and the effectiveness of specific interventions like iron-folic acid supplementation, females, particularly those of reproductive age and older adults, continue to face higher rates. Socio-economic improvements, including higher income and better human development, are linked to lower anemia rates, though the impact differs by gender. The persistent gender disparity and the shift in burden to older adults highlight the need for more comprehensive, gender-sensitive interventions. Future efforts should integrate nutritional support with broader socio-economic enhancements to effectively address anemia and improve public health in Vietnam.

Compliance with weekly iron folic acid supplementation and associated factors among secondary school adolescent girls, in Jimma Arjo District, West Ethiopia, 2022: A mixed method cross-sectional Study

Background: Iron deficiency anemia is a prevalent and major public health problem in low- and middle-income countries among adolescent girls. The risk of Iron deficiency anemia and its consequences are prevented by taking and complying with a weekly iron-folic acid supplement. However, there was no information regarding compliance and its associated factors in Ethiopia. The study aimed to determine the magnitude of compliance with weekly Iron-folic acid supplementation and associated factors among Jimma Arjo secondary school adolescent girls. Methods: Institutional-based cross-sectional study was conducted on 417 adolescent girls in three secondary schools of Jimma Arjo, West Ethiopia from March 1st to 31st, 2022 using interviewer-administered structured and semi-structured questionnaires. Bivariable and multivariable logistic regression analyses were used to determine the association of variables. Results: Compliance with iron-folic acid supplementation was 29.3% with 95% CI (24.9, 33.3). Mother`s secondary level of education (AOR=4.94 (95% CI:2.45,9.94)), awareness of anemia (AOR=4.23 (95% CI:2.35,7.61)), good knowledge about iron-folic acid supplementation (AOR=3.96 (95% CI:2.17,7.22)), lack of iron-folic acid supplementation (AOR=0.42 (95% CI:0.23,0.75)), and iron-folic acid supplementation side effects (AOR=0.17 (95% CI:0.08,0.37)) were factors significantly associated with iron-folic acid supplementation compliance. Misconceptions about iron-folic acid supplementation, forgetfulness of tablet, lack of access to drinking water, and irregularity of school weekly iron-folic acid supplementation days were identified as the main barriers to adolescent girls' compliance with iron-folic acid supplementation in a qualitative study. Conclusions: Weekly iron-folic acid supplementation compliance was low at 29.3%. Scheduled health education, parental participation in the program, access to drinking water, refresher training for school focal persons, and fixed weekly iron-folic acid supplementation days can improve compliance with iron-folic acid supplementation and are recommended.

Temporal trends and practice variation of paediatric diagnostic tests in primary care: retrospective analysis of 14 million tests

ObjectiveThe primary objective was to investigate temporal trends and between-practice variability of paediatric test use in primary care.Methods and analysisThis was a descriptive study of population-based data from Clinical Practice...

Exploring factors affecting adherence to multiple micronutrient supplementation during pregnancy in Cambodia: A qualitative analysis.

For decades, iron-folic acid (IFA) supplements have been provided to pregnant women in Cambodia through antenatal care (ANC) services. However, mounting evidence suggests that multiple micronutrient supplements (MMS) are superior to IFA supplements in achieving positive pregnancy outcomes. The possibility of transitioning from IFA supplements to MMS in government-run health centres is currently being assessed in Cambodia. A crucial component of this assessment involves identifying factors that can influence adherence to MMS, as low adherence can reduce supplement effectiveness. Consequently, this study aimed to explore the potential barriers and enablers to MMS adherence and identify the strengths and challenges of current ANC services. Data were collected through nine focus group discussions with pregnant women (n = 19), family members (n = 18) and midwives (n = 18) and three in-depth interviews with maternal and child health chiefs (n = 3) in Cambodia and analysed via content analysis. Factors found to influence MMS adherence included attitudes, perceptions and beliefs about MMS; knowledge related to supplementation; ANC counselling; family influence; physical health; access to ANC; supply of MMS; and supplementation norms. Noted strengths of ANC services were the quality of ANC materials, tailored patient education, midwife-patient relationships and flexibility of provided services. Primary challenges related to poor availability of ANC materials, inadequate midwife training, heavy workload, limited funding and suboptimal physical spaces for delivering ANC services. To effectively promote MMS adherence, strategies must involve pregnant women, family members and community leaders; seek to address knowledge gaps and misconceptions related to MMS; and enhance the availability and accessibility of ANC services.

Routine uptake of prenatal iron-folic acid supplementation and associated factors among pregnant women in peri-urban areas of Dodoma City, Tanzania: a cross-sectional study

BackgroundThe physiological requirements for iron and folic acid in pregnancy are a significant challenge to achieve through normal dietary intake, especially in low resource settings. The World Health Organization recommends daily oral iron and folic acid supplementation (IFAS) to prevent maternal anaemia and related adverse effects in community settings where the prevalence of anaemia during pregnancy is > 40%. The objective of this study was to assess the routine uptake of prenatal iron-folic acid supplementation and associated factors among pregnant women at peri-urban areas of Dodoma City, Tanzania.MethodsA cross-sectional study was conducted in peri-urban areas. Data was collected through face-to-face interviews and review of records from maternal clinic card (RCH 4 card). Routine uptake of iron-folic acid supplementation was defined as pregnant woman who reported taking iron-folic acid supplements at least once within the past seven days prior to data collection. Frequency and percentage were used to report respondents’ characteristics and uptake of prenatal iron-folic acid supplementation. Chi-square test and logistic regression were conducted to determine the relationship and association of routine uptake of iron-folic acid supplementation with respondents’ characteristics.ResultsThe total respondents were 452. Overall routine uptake of iron-folic acid supplementation was 35.6% (161). The majority of the respondents (66.5%) initiated iron-folic acid supplementation during the second trimester of pregnancy. Most of the respondents (86.3%) obtained IFA supplements at the health centers where they were receiving antenatal care. The prevalence of routine uptake of iron-folic acid supplementation was significantly higher among women in the third trimester of pregnancy (54.9%), those with more than a five-year interval since last pregnancy (40.6%), those with at least four antenatal care (ANC) visits (73.7%) and women who had undergone haemoglobin testing in the current pregnancy (63.0%). Factors associated with routine uptake of iron-folic acid supplementation were; frequency of ANC visits (AOR = 1.69) and haemoglobin testing (AOR = 3.02).ConclusionApproximately one third of the pregnant women took iron-folic acid supplementation at least once a week. The current frequency for intake of iron-folic acid supplementation can be described as intermittent. This practise is unacceptable for prevention of maternal anaemia and associated adverse pregnant outcomes. Frequency of ANC visits and haemoglobin testing during pregnancy were found to be associated with routine uptake of iron-folic acid supplements. Stakeholders are urged to consider novel systems for provision of prenatal IFAS in community settings with limited access to health-care professionals to ensure a timely and continuous supply of supplements.