Time for change is now: Experiences of participants in a community-based approach for iron and folic acid supplementation in a rural county in Kenya, a qualitative study


Autoři: Mary Wanjira Kamau aff001
Působiště autorů: School of Nursing Sciences, College of Health Sciences, University of Nairobi, Nairobi, Kenya aff001
Vyšlo v časopise: PLoS ONE 15(1)
Kategorie: Research Article
doi: 10.1371/journal.pone.0227332

Souhrn

Background

Iron and Folic Acid Supplementation (IFAS) is recommended by World Health Organization as part of antenatal care to prevent anaemia in pregnancy. In 2010, Kenya adopted this recommendation and the current policy is to provide one combined IFAS tablet for daily use throughout pregnancy, free of charge, in all public health facilities. However, adherence remains low over the years though anaemia in pregnancy remains high. Integration of IFAS into community-based interventions has been recommended because of its excellent outcome. Using Community Health Volunteers (CHVs) to distribute IFAS has not been implemented in Kenya before.

Methods

Following an intervention study implementing a community-based approach for IFAS in five public health facilities in Lari Sub-County, 19 interviews were conducted among CHVs, nurses and pregnant women participating to describe their experiences. Thematic analysis of data was done using NVivo and findings described, with use of quotes.

Findings

The nurses, CHVs and pregnant women were all positive and supportive of community-based approach for IFAS. They reported increased access and utilization of both IFAS and antenatal services leading to perceived reduction in anaemia and better pregnancy outcomes. Counselling provided by CHVs improved IFAS knowledge among pregnant women and consequent adherence. The increased IFAS utilization led to main challenge experienced being IFAS stock-outs. All participants recommended complementing antenatal IFAS distribution approach with community-based approach for IFAS.

Conclusion

Using CHVs to implement a community-based approach for IFAS was successful and increased supplement awareness and utilization. However, the role of CHVs in IFAS programme implementation is not clearly defined in current policy and their potential in IFAS education and distribution is not fully utilized. All participants endorsed integration of community-based approach for IFAS into the antenatal approach to enhance IFAS coverage and adherence among pregnant women for better pregnancy outcomes.

Klíčová slova:

Anemia – Antenatal care – Community based intervention – Health education and awareness – Health systems strengthening – Nurses – Pregnancy – Public and occupational health


Zdroje

1. WHO. Essential Nutrition Actions: Improving maternal, newborn, infant and young child health and nutrition. Geneva: World Health Organization; 2013.

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

4. KNBS, Macro ICF. Kenya Demographic and Health Survey 2014. Nairobi: Kenya National Bureau of Statistics; 2015.

5. 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 and child health journal. 2013;17(7):1236–42. Epub 2012/08/22. doi: 10.1007/s10995-012-1120-x 22907273.

6. 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.

7. 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. Int J Prev Med. 2013;4(10):1213–6. Epub 2013/12/10. 24319564.

8. Nisar YB, Dibley MJ, Mir AM. Factors associated with non-use of antenatal iron and folic acid supplements among Pakistani women: a cross sectional household survey. BMC Pregnancy Childbirth. 2014;14:305. Epub 2014/09/06. doi: 10.1186/1471-2393-14-305 25189220.

9. Galloway R, Dusch E, Elder L, Achadi E, Grajeda R, Hurtado E, et al. Women’s perceptions of iron deficiency and anemia prevention and control in eight developing countries. Soc Sci Med. 2002;55. doi: 10.1016/s0277-9536(01)00185-x

10. Mithra P, Unnikrishnan B, Rekha T, Nithin K, Mohan K, Kulkarni V, et al. Compliance with iron-folic acid (IFA) therapy among pregnant women in an urban area of south India. African Health Sciences. 2014;14(1).

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

12. Siekmans K, Roche M, Kung’u JK, Desrochers RE, De-Regil LM. Barriers and enablers for iron folic acid (IFA) supplementation in pregnant women. Maternal & Child Nutrition. 0(0):e12532. doi: 10.1111/mcn.12532 29271115

13. Charoenlarp P, Dhanamitta S, Kaewvichit R, Silprasert A, Suwanaradd C, Na-Nakorn S, et al. A WHO collaborative study on iron supplementation in Burma and in Thailand. Am J Clin Nutr. 1988;47.

14. Alam A, Rasheed S, Khan NUZ, 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

15. Bhutta ZA, Darmstadt GL, Hasan BS, Haws RA. Community-based interventions for improving perinatal and neonatal health outcomes in developing countries: a review of the evidence. Pediatrics. 2005;115(2 Suppl):519–617. doi: 10.1542/peds.2004-1441 15866863.

16. Kc A, Thapa K, Pradhan YV, Kc NP, Upreti SR, Adhikari RK, et al. Developing community-based intervention strategies and package to save newborns in Nepal. J Nepal Health Res Counc. 2011;9(2):107–18. 22929839.

17. Shah NM, Brieger WR, Peters DH. Can interventions improve health services from informal private providers in low and middle-income countries?: a comprehensive review of the literature. Health Policy Plan. 2011;26(4):275–87. doi: 10.1093/heapol/czq074 21097784.

18. Community Directed Interventions Study Group. Community-directed interventions for priority health problems in Africa: results of a multicountry study. Bull World Health Organ. 2010;88(7):509–18. Epub 2010/07/10. doi: 10.2471/BLT.09.069203 20616970.

19. Yip R. Iron supplementation: country level experiences and lessons learned. Journal of Nutrition. 2002;132(859S–861S). doi: 10.1093/jn/132.4.859S 11925498

20. MICAH. Malawi final survey report. World Vision. 2006.

21. Witmer A, Seifer SD, Finocchio L, Leslie J, O’Neil EH. Community health workers: integral members of the health care work force. American Journal of Public Health. 1995;85(8_Pt_1):1055–8. doi: 10.2105/ajph.85.8_pt_1.1055 7625495

22. Perry H, Zulliger R. How Effective are Community Health Workers? An Overview of Current Evidence with Recommendations for Strengthening Community Health Worker Programs to accelerate Progress in Achieving the Health-related Millennium Development Goals. HRH Global Resource Center Johns Hopkins Bloomberg School of Public Health, International Health and Health BaS; 2012.

23. Vaughan K, Kok MC, Witter S, Dieleman M. Costs and cost-effectiveness of community health workers: evidence from a literature review. Hum Resour Health. 2015;13:71. doi: 10.1186/s12960-015-0070-y 26329455.

24. WHO. Strengthening The Performance Of Community Health Workers In Primary Health Care: report of a WHO Study Group. Geneva: Group WS; 1989.

25. Ministry of Health. Strategy for Community Health 2014–2019. In: Community Health Service Unit, editor. Nairobi. 2014.

26. Ministry of Public Health and Sanitation. National Communication Strategy for Community Health Services. In: Community Health Services Unit, editor. Nairobi. 2012.

27. European Commission. What drives community health services in Kenya, Position Paper No.1. Nairobi: Austrian Development Cooperation; 2012.

28. COUNTY GOVERNMENT OF KIAMBU. Politcal Units 2018 [cited 2018 14/01/2018]. https://kiambu.go.ke/political-units/.

29. 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

30. 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).

31. Burnard P, Gill P, Stewart K, Treasure E, Chadwick B. Analysing and presenting qualitative data. Br Dent J. 2008;204(8):429–32. Epub 2008/04/29. doi: 10.1038/sj.bdj.2008.292 18438371.

32. Clarke V, Braun V. Teaching thematic analysis: Overcoming challenges and developing strategies for effective learning. Psychologist. 2013;26(2):120–3.

33. Maguire M, Delahunt B. Doing a thematic analysis: A practical, step-by-step guide for learning and teaching scholars. All Ireland Journal of Higher Education; Vol 9, No 3 (2017). 2017.

34. Kavle JA, Landry M. Community-based distribution of iron–folic acid supplementation in low- and middle-income countries: a review of evidence and programme implications. Public Health Nutrition. 2017;21(2):346–54. Epub 10/24. doi: 10.1017/S1368980017002828 29061205

35. Kane S, Gerretsen B, Scherpbier R, Dal Poz M, Dieleman M. A realist synthesis of randomised control trials involving use of community health workers for delivering child health interventions in low and middle income countries. BMC Health Serv Res. 2010;10. doi: 10.1186/1472-6963-10-286 20942900

36. Bigirwa P. Effectiveness of community health workers (CHWS) in the provision of basic preventive and curative maternal, newborn and child health (MNCH) interventions: A systematic review. Health Policy and Development. 2009;7(3):162–72.

37. Jaskiewicz W, Tulenko K. Increasing community health worker productivity and effectiveness: a review of the influence of the work environment. Human Resources for Health. 2012;10:38-. doi: 10.1186/1478-4491-10-38 23017131

38. George A, Young M, Nefdt R, Basu R, Sylla M, Clarysse G, et al. Community Health Workers Providing Government Community Case Management for Child Survival in Sub-Saharan Africa: Who Are They and What Are They Expected to Do? The American Journal of Tropical Medicine and Hygiene. 2012;87(5 Suppl):85–91. doi: 10.4269/ajtmh.2012.11-0757 23136282

39. Pattanee W. Prevention and Control of Anemia: Thailand Experiences. Journal of Nutrition. 2002;132(862S–866S). doi: 10.1093/jn/132.4.862S 11925499

40. Sanghvi TG, Harvey PW, Wainwright E. Maternal iron-folic acid supplementation programs: evidence of impact and implementation. Food Nutr Bull. 2010;31(2 Suppl):S100–7. Epub 2010/08/19. doi: 10.1177/15648265100312S202 20715594.

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

42. Gogia S, Sachdev HS. Home visits by community health workers to prevent neonatal deaths in developing countries: a systematic review. Bulletin of the World Health Organization. 2010;88(9):658–66B. doi: 10.2471/BLT.09.069369 20865070

43. Lassi ZS, Haider BA, Bhutta ZA. Community-based intervention packages for reducing maternal and neonatal morbidity and mortality and improving neonatal outcomes. Cochrane Database Syst Rev. 2010;(11):CD007754. doi: 10.1002/14651858.CD007754.pub2 21069697.

44. Lewin SA, Babigumira SM, Bosch-Capblanch X, Aja G, Van Wyk B, Genton C, et al. Lay health workers (LHWs) in primary and community health care: A systematic review of trials. Cochrane Database Syst Rev: 2005.

45. Gill CJ, Phiri-Mazala G, Guerina NG, Kasimba J, Mulenga C, MacLeod WB, et al. Effect of training traditional birth attendants on neonatal mortality (Lufwanyama Neonatal Survival Project): randomised controlled study. BMJ. 2011;342.

46. Wilson A, Gallos ID, Plana N, Lissauer D, Khan KS, Zamora J, et al. Effectiveness of strategies incorporating training and support of traditional birth attendants on perinatal and maternal mortality: meta-analysis. BMJ. 2011;343.

47. Ara G, Khanam M, Papri N, Nahar B, Haque MA, Kabir I, et al. Peer counselling improves breastfeeding practices: A cluster randomized controlled trial in urban Bangladesh. Maternal & Child Nutrition. 2018;14(3):e12605. doi: 10.1111/mcn.12605 29660858

48. Tinago CB, Annang Ingram L, Blake CE, Frongillo EA. Individual and structural environmental influences on utilization of iron and folic acid supplementation among pregnant women in Harare, Zimbabwe. Maternal & Child Nutrition. 2017;13(3):e12350. doi: 10.1111/mcn.12350 27502366

49. 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).

50. Campaore A, Gies S, Brabin BJ, Tinto H, Brabin L. “There is iron and iron…” Burkinabè women’s perceptions of iron supplementation: a qualitative study. Maternal and child health journal. 2014;18(8).

51. Elder LK. Issues in programming for maternal anaemia. Mother Care: Mother Care, 2000.

52. Martin SL, Seim GL, Wawire S, Chapleau GM, Young SL, Dickin KL. Translating formative research findings into a behaviour change strategy to promote antenatal calcium and iron and folic acid supplementation in western Kenya. Maternal & Child Nutrition. 2017;13(1). doi: 10.1111/mcn.12233 26898417

53. 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. doi: 10.1111/mcn.12424 29493899

54. 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. Epub 2012/08/22. doi: 10.1007/s10995-012-1120-x 22907273.

55. Gebremedhin S, Aregash S, Girma M, Tibebu M, Tsehai A. 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.

56. Omotayo MO, Dickin KL, Pelletier DL, Martin SL, Kung’u JK, Stoltzfus RJ. Feasibility of integrating calcium and iron–folate supplementation to prevent preeclampsia and anemia in pregnancy in primary healthcare facilities in Kenya. Maternal & Child Nutrition. 2018;14(S1):e12437. doi: 10.1111/mcn.12437 29493897

57. 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;14:344. doi: 10.1186/1471-2393-14-344 25269515

58. Shakir F. Community Health Worker Programs: A Review of Recent Literature. USAID Health Care Improvement Project, 2010.


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