#PAGE_PARAMS# #ADS_HEAD_SCRIPTS# #MICRODATA#

Effect of community based health education on knowledge and attitude towards iron and folic acid supplementation among pregnant women in Kiambu County, Kenya: A quasi experimental study


Autoři: Mary Kamau aff001;  Waithira Mirie aff001;  Samuel Kimani aff001;  Isaac Mugoya aff002
Působiště autorů: School of Nursing Sciences, University of Nairobi, Nairobi, Kenya aff001;  John Snow Inc., Nairobi, Kenya aff002
Vyšlo v časopise: PLoS ONE 14(11)
Kategorie: Research Article
doi: https://doi.org/10.1371/journal.pone.0224361

Souhrn

Introduction

Iron and Folic Acid Supplementation (IFAS) services are currently provided free of charge to pregnant women in Kenya during antenatal care (ANC) but compliance remains low. Poor awareness is an important factor contributing to low utilization of IFAS. Inadequate counselling is one of the key factors associated with poor awareness on IFAS. Community based health education is a promising diversification strategy for IFAS health education to curb this problem.

Objectives

To determine effect of community based IFAS health education, utilizing CHVs, on IFAS knowledge, levels of counselling on various IFAS topics and attitude towards IFAS among pregnant women in Kiambu County.

Methodology

A Pretest-Posttest Quasi-Experimental study design, consisting of intervention and control group, was applied among 340 pregnant women 18–49 years, in five health facilities, selected using two stage sampling in Lari Sub-County, Kiambu County, Kenya. Community health volunteers provided IFAS health education with weekly supplements and follow-ups to pregnant women in intervention group, while control group received the same from health care providers. Baseline and endline data were collected during ANC and compared. Quantitative data was analyzed using STATA version 14. Analysis of effect of intervention was done using Difference-In-Difference approach.

Results

There was an effect difference in maternal IFAS knowledge of 13%, with intervention group levels increasing most by 35 percentage points. The odds of being knowledgeable were 3 times more at endline than baseline. There was significant (p<0.001) change in proportion with positive attitude towards IFAS: the odds of having positive attitude at endline was 9 times that of baseline (OR = 9.2:95%CI 3.1, 27.2).

Conclusion

Implementation of community based health education improved maternal knowledge, positive attitude and proportion of pregnant women counselled on IFAS, better improvement being recorded in intervention group. Hence, there is need to integrate community based approach with antenatal IFAS distribution to improve supplementation.

Klíčová slova:

anémia – Antenatal care – Communications – Folic acid – Health care providers – Health education and awareness – Iron deficiency anemia – Pregnancy


Zdroje

1. WHO. Nutritional Anaemias: Tools for Effective Prevention and Control. Geneva: World Health Ognanization; 2017.

2. MoH. National Policy Guideline on combined iron and folic acid (IFA) supplementation for pregnant mothers in Kenya. In: Division of Nutrition, editor. Nairobi2013.

3. Kamau M, Kimani S, Mirie W. Counselling on iron and folic acid supplementation (IFAS) is associated with improved knowledge among pregnant women in a rural county of Kenya: a cross-sectional study [version 1; referees: awaiting peer review]. AAS Open Research. 2018;1(21).

4. Gebremariam AD, Tiruneh SA, Abate BA, Engidaw MT, Asnakew DT. Adherence to iron with folic acid supplementation and its associated factors among pregnant women attending antenatal care follow up at Debre Tabor General Hospital, Ethiopia, 2017. PLOS ONE. 2019;14(1):e0210086. doi: 10.1371/journal.pone.0210086 30615646

5. Pouchieu C, Lévy R, Faure C, Andreeva VA, Galan P, Hercberg S, et al. Socioeconomic, Lifestyle and Dietary Factors Associated with Dietary Supplement Use during Pregnancy. PLOS ONE. 2013;8(8):e70733. doi: 10.1371/journal.pone.0070733 23967094

6. Gebreamlak B, Dadi AF, Atnafu A. High Adherence to Iron/Folic Acid Supplementation during Pregnancy Time among Antenatal and Postnatal Care Attendant Mothers in Governmental Health Centers in Akaki Kality Sub City, Addis Ababa, Ethiopia: Hierarchical Negative Binomial Poisson Regression. PLOS ONE. 2017;12(1):e0169415. doi: 10.1371/journal.pone.0169415 28129344

7. Birhanu Z, Chapleau GM, Ortolano SE, Mamo G, Martin SL, Dickin KL. Ethiopian women's perspectives on antenatal care and iron-folic acid supplementation: Insights for translating global antenatal calcium guidelines into practice. Maternal & Child Nutrition. 2018;14(S1):e12424.

8. Bilimale A, Anjum A. Improving adherence to oral iron supplementation during pregnancy. Australasian Medical Journal 2010;3(5):281–90.

9. Ilmas T. Master’s Thesis: Knowledge, Attitudes and Practices Regarding Iron and Folic Acid Supplementation among Pregnant Women in Gujranwala, Pakistan. Faculty of Health Sciences2018.

10. MCSP. MCSP Nutrition Brief. Community-Based Distribution of Iron-Folic Acid Supplementation: Evidence and Program Implications. MCSP; 2017.

11. Nisar Y, Michael JD, Ali MM. Factors associated with non-use of antenatal iron and folic acid supplements among Pakistani women: a cross sectional household survey. BMC Pregnancy Childbirth. 2014;14(1):305.

12. MoH. Accelerating reduction of iron deficiency anaemia among pregnant women in Kenya: Plan of action 2012–2017. In: Division of Nutrition, editor. Nairobi2012.

13. Nisar YB, Dibley MJ. Earlier Initiation and Use of a Greater Number of Iron-Folic Acid Supplements during Pregnancy Prevents Early Neonatal Deaths in Nepal and Pakistan. PLOS ONE. 2014;9(11):e112446. doi: 10.1371/journal.pone.0112446 25398011

14. MoH. National Iron and Folic Acid Supplementation; Communication Strategy, 2013–2017. In: Division of Nutrition, editor. Nairobi2013.

15. Gebremedhin S, Samuel A, Mamo G, Moges T, Assefa T. Coverage, compliance and factors associated with utilization of iron supplementation during pregnancy in eight rural districts of Ethiopia: a cross-sectional study. BMC public health. 2014;14:607. doi: 10.1186/1471-2458-14-607 24930036

16. Pal PP, Sharma S, Sarkar TK, Mitra P. Iron and Folic Acid Consumption by the Ante-natal Mothers in a Rural Area of India in 2010. International Journal of Preventive Medicine. 2013;4(10):1213–6. 24319564

17. Yekta Z, Ayatollahi H, Pourali R, Farzin A. Predicting Factors in Iron Supplement Intake among Pregnant Women in Urban Care Setting. J Res Health Sci. 2008;8(1):39–45. 23343996

18. Maina-Gathigi L, Omolo J, Wanzala P, Lindan C, Makokha A. Utilization of folic acid and iron supplementation services by pregnant women attending an antenatal clinic at a regional referral hospital in Kenya. Maternal Child Health Journal. 2013;17(7):1236–42. doi: 10.1007/s10995-012-1120-x 22907273

19. Aguayo VM, Koné D, Bamba SI, Diallo B, Sidibé Y. Acceptability of multiple micronutrient supplements by pregnant and lactating women in Mali. Public Health Nutrition. 2005;8(1):33–7. doi: 10.1079/phn2005665 15705243

20. Muro GS, Gross U, Gross R, Wahyuniar L. Increase in compliance with weekly iron supplementation of adolescent girls by an accompanying communication programme in secondary schools in Dar-es-Salaam, Tanzania. Food and Nutrition Bulletin. 1999;20(4):435–44.

21. Alam A, Rasheed S, Khan NU, Sharmin T, Huda TM, Arifeen SE, et al. How can formative research inform the design of an iron-folic acid supplementation intervention starting in first trimester of pregnancy in Bangladesh? BMC public health. 2015;15:374. doi: 10.1186/s12889-015-1697-2 25887449

22. Kamau MW, Mirie W, Kimani S. Compliance with Iron and folic acid supplementation (IFAS) and associated factors among pregnant women: results from a cross-sectional study in Kiambu County, Kenya. BMC public health. 2018;18(1):580. doi: 10.1186/s12889-018-5437-2 29720135

23. Demidenko E. Sample size and optimal design for logistic regression with binary interaction. Stat Med. 2008;27(1):36–46. doi: 10.1002/sim.2980 17634969

24. Mahmoud A-HAW. Iron Deficiency Anemia among Pregnant Women in Nablus District; Prevalence, Knowledge, Attitude and Practices. Nablus, Palestine: An-Najah National University; 2007.

25. Ahamed NHK, S.A.M; Hassanen R.H. Knowledge and Attitude of Pregnant Women about Iron Deficiency Anemia in Assist University Women Health Hospital,Egypt. Journal of Nursing and Health Science. 2018;7(3):49–58.

26. Getachew M, Abay M, Zelalem H, Gebremedhin T, Grum T, Bayray A. Magnitude and factors associated with adherence to Iron-folic acid supplementation among pregnant women in Eritrean refugee camps, northern Ethiopia. BMC Pregnancy and Childbirth. 2018;18(1):83. doi: 10.1186/s12884-018-1716-2 29621996

27. Kothari CR, Garg G. Research Methodology: Methods and Techniques. Third ed. New Delhi: New Age International Publishers; 2014. 449 p.

28. Owusu-Darko I, Kwasi Adu I, Frempong N. Application of generalized estimating equation (GEE) model on students' academic performance. 2014:3359–74.

29. Lee JH, Herzog TA, Meade CD, Webb MS, Brandon TH. The use of GEE for analyzing longitudinal binomial data: a primer using data from a tobacco intervention. Addict Behav. 2007;32(1):187–93. doi: 10.1016/j.addbeh.2006.03.030 16650625

30. Wang M. Generalized Estimating Equations in Longitudinal Data Analysis: A Review and Recent Developments. Advances in Statistics. 2014;2014:1–11.

31. MCHIP. Community-based distribution for routine Iron/folic acid supplementation in pregnancy. Maternal and Child Health Integrated Program, USAID, Nairobi; 2014.

32. Wiradnyani LAA, Khusun H, Achadi EL, Ocviyanti D, Shankar AH. Role of family support and women’s knowledge on pregnancy-related risks in adherence to maternal iron–folic acid supplementation in Indonesia. Public Health Nutrition. 2016;19(15):2818–28. doi: 10.1017/S1368980016001002 27181394

33. WHO. Guideline: Daily iron and folic acid supplementation in pregnant women. Geneva: World Health Organization 2012.

34. Al-Akhfash AA, Abdulla AM, Osman AM, Abdulgafar JI, Almesned AA. Maternal knowledge and use of folic acid among Saudi females. Saudi Med J. 2013;34(11):1173–8. 24252897

35. Titaley CR. Factors associated with not using antenatal iron/folic acid supplements in Indonesia: the 2002/2003 and 2007 Indonesia Demographic and Health Survey. Asia Pacific Journal of Clinical Nutrition. 2014;23(4).

36. Nisar YB, Alam A, Aurangzeb B, Dibley MJ. Perceptions of antenatal iron-folic acid supplements in urban and rural Pakistan: a qualitative study. BMC Pregnancy and Childbirth. 2014;14(1):1–12.

37. Shivalli S, Srivastava RK, Singh GP. Trials of Improved Practices (TIPs) to Enhance the Dietary and Iron-Folate Intake during Pregnancy- A Quasi Experimental Study among Rural Pregnant Women of Varanasi, India. PLoS ONE. 2015;10(9):e0137735. doi: 10.1371/journal.pone.0137735 26367775

38. Al-Hossani H, Abouzeid H, Salah MM, Farag HM, Fawzy E. Knowledge and practices of pregnant women about folic acid in pregnancy in Abu Dhabi, United Arab Emirates. East Mediterr Health J. 2010;16(4):402–7. 20795424

39. Taye B, Abeje G, Mekonen A. Factors associated with compliance of prenatal iron folate supplementation among women in Mecha district, Western Amhara: a cross-sectional study. Pan Afr Med J. 2015;20:43. doi: 10.11604/pamj.2015.20.43.4894 26090001

40. Arega Sadore A, Abebe Gebretsadik L, Aman Hussen M. Compliance with Iron-Folate Supplement and Associated Factors among Antenatal Care Attendant Mothers in Misha District, South Ethiopia: Community Based Cross-Sectional Study. Journal of Environmental and Public Health. 2015:781973. doi: 10.1155/2015/781973 26839573

41. Abdullahi H, Gasim GI, Saeed A, Imam AM, Adam I. Antenatal iron and folic acid supplementation use by pregnant women in Khartoum, Sudan. BMC Research Notes. 2014;7(1):498.

42. Rai S. Compliance and its Determinants Regarding Iron and Folic Acid Supplementation among Pregnant Women Attending Paropakar Maternity and Women’s Hospital, Kathmandu, Nepal. Nepal: Nepal Health Research Council; 2013.

43. Tenaw Z, Arega M, Tachbele E. Nutritional knowledge, attitude and practices among pregnant women who attend antenatal care at public hospitals of Addis Ababa, Ethiopia. International Journal of Nursing and Midwifery. 2018;10(7):81–9.

44. Galloway R, McGuire J. Determinants of compliance with iron supplementation: supplies, side effects, or psychology? Soc Sci Med. 1994;39. doi: 10.1016/0277-9536(94)90164-3

45. Matiri E, Pied E, Galloway R, Wawire S, Velez O, D C. Improving Iron-Folic Acid and Calcium Supplementation Compliance through Counseling, Reminder Cards, and Cell Phone Messages in Kenya. Maternal and Child Health Integrated Program (MCHIP); 2017.

46. Alam A, Rasheed S, Khan NU, Sharmin T, Huda TM, Arifeen SE, et al. How can formative research inform the design of an iron-folic acid supplementation intervention starting in first trimester of pregnancy in Bangladesh? BMC public health. 2015;15(1):374.

47. Seck BC, Jackson RT. Determinants of compliance with iron supplementation among pregnant women in Senegal. Public Health Nutrition. 2008;11(6):596–605. doi: 10.1017/S1368980007000924 17764606

48. MoH. IFAS Dialogue guide for health care providers. In: Division of Nutrition, editor. Nairobi2012.

49. Saprii L, Richards E, Kokho P, Theobald S. Community health workers in rural India: analysing the opportunities and challenges Accredited Social Health Activists (ASHAs) face in realising their multiple roles. Hum Resour Health. 2015;13:95. doi: 10.1186/s12960-015-0094-3 26646109

50. Wendt A, Young M, Stephenson R, Webb Girard A, Ramakrishnan U, Martorell R. Antenatal care and counseling measures increase iron and folic acid receipt among pregnant women in Bihar, India (256.3). The FASEB Journal. 2014;28(1 Supplement).

51. Bruce ML, Smith W, Miranda J, Hoagwood K, Wells KB. Community-Based Interventions. Mental Health Services Research. 2002;4(4):205–14. doi: 10.1023/a:1020912531637 12558005

52. Klassen TP, MacKay JM, Moher D, Walker A, Jones AL. Community-based injury prevention interventions. Future Child. 2000;10(1):83–110. 10911689

53. Liu N, Mao L, Sun X, Liu L, Yao P, Chen B. The effect of health and nutrition education intervention on women's postpartum beliefs and practices: a randomized controlled trial. BMC public health. 2009;9(1):45.

54. Nuno L, Teresa R, Sofia C, Henrique B. Adequacy of prenatal care as a major determinant of folic acid, iron, and vitamin intake during pregnancy. Cad Saúde Pública, Rio de Janeiro,. 2008;24(5):1151–7.


Článek vyšel v časopise

PLOS One


2019 Číslo 11
Nejčtenější tento týden
Nejčtenější v tomto čísle
Kurzy

Zvyšte si kvalifikaci online z pohodlí domova

KOST
Koncepce osteologické péče pro gynekology a praktické lékaře
nový kurz
Autoři: MUDr. František Šenk

Sekvenční léčba schizofrenie
Autoři: MUDr. Jana Hořínková

Hypertenze a hypercholesterolémie – synergický efekt léčby
Autoři: prof. MUDr. Hana Rosolová, DrSc.

Svět praktické medicíny 5/2023 (znalostní test z časopisu)

Imunopatologie? … a co my s tím???
Autoři: doc. MUDr. Helena Lahoda Brodská, Ph.D.

Všechny kurzy
Kurzy Podcasty Doporučená témata Časopisy
Přihlášení
Zapomenuté heslo

Zadejte e-mailovou adresu, se kterou jste vytvářel(a) účet, budou Vám na ni zaslány informace k nastavení nového hesla.

Přihlášení

Nemáte účet?  Registrujte se

#ADS_BOTTOM_SCRIPTS#