Iron requirements in pregnancy and strategies to meet them. Discussion

Background: Anemia is a major nutritional problem in Indonesian, one of the occurs in pregnant women. Therefore the government issued prevention and control program of iron deficiency anemia through consecutive iron supplementation for at least 90 days during pregnancy. Objectives: This study aimed to analyze the influence of age, education and knowledge of consumption of iron tablets. Methods: This research was conducted in Maron Public Health Center, District of Probolinggo using a cross sectional design. A sample of 40 pregnant women in their last trimester who have received 90 iron tablets was recruited with a simple random sampling technique. The influence of age, education, and knowledge was analyzed using logistic regression test with significance value < 0,05. Results: The results showed that the knowledge of pregnant women affected of consumption of iron tablets (p=0.026), but age (p=0.914), education (p=0.419) did not affected of consumption of iron tablets. Conclusion: The conclusion of this research is that consumption of iron tablets in pregnant women is influenced by knowledge of pregnant women. The lack knowledge of the mother, the lower the level consumption of iron tablets. ABSTRAK Latar Belakang: Anemia merupakan masalah gizi utama di Indonesia, salah satunya terjadi pada ibu hamil. Oleh karena itu pemerintah mengeluarkan program pencegahan dan pengendalian anemia defisiensi besi melalui suplementasi besi berturut-turut selama setidaknya 90 hari selama kehamilan. Tujuan: Tujuan penelitian ini untuk menganalisis pengaruh usia, pendidikan, dan pengetahuan terhadap konsumsi tablet tambah darah. Metode: Penelitian ini dilakukan di Puskesmas Maron, Kabupaten Probolinggo menggunakan desain cross sectional , sampel sebanyak 40 ibu hamil TM III yang mendapatkan 90 tablet besi dengan teknik simple random sampling. Pengaruh usia, pendidikan, dan pengetahuan dianalisis menggunakan uji regresi logistik dengan nilai signifikansi <0,05. Hasil: Hasil penelitian menunjukkan bahwa pengetahuan ibu hamil berpengaruh terhadap konsumsi tablet besi (p = 0.026) , tapi usia (p = 0.914), pendidikan (p = 0.419) tidak berpengaruh terhadap konsumsi tablet besi. Kesimpulan: Konsumsi tablet besi pada ibu hamil dipengaruhi oleh pengetahuan ibu hamil. Rendahnya pengetahuan ibu, maka akan tingkat konsumsi tablet tambah darah semakin rendah.

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Pengaruh Usia, Pendidikan, dan Pengetahuan Terhadap Konsumsi Tablet Tambah Darah pada Ibu Hamil di Puskesmas Maron, Kabupaten Probolinggo

Background Anemia is one of the world's leading cause of disability and the most serious global public health issues. This systematic review and meta-analysis was conducted very carefully in order to give up the pooled compliance of Iron and Folic-Acid Supplementation in Sub-Saharan Africa. Methods To conduct this brief systematic review and meta-analysis, a related literature search was done from different sources, PubMed Medline and Google Scholar Journals. Then IFA Supplementation related searching engine was used to make the work more meaningful and intensive. Moreover, we used modified Newcastle-Ottawa quality assessment scale for cross sectional studies to assess the quality of the study in terms of their inclusion. Then, the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline was followed to carry out the work in a carful manner. Finally, the pooled effect size was computed using the review manager and Compressive Meta-analysis software. Results Twenty-three studies, which encompassed 24272 pregnant women, were chosen for the analysis. From those an overall prevalence of compliance with Iron and Folic Acid Supplementation (IFAS) in pregnancy in SSA was 39.2%. However, the result from meta-analysis showed that women who were counseled on IFAS in their courses of pregnancy were 1.96 times more likely to adhere to IFAS compared to those who were not counseled [OR:1.96, 95% CI (1.76-,5.93)]. Moreover, it showed that women who had knowledge of IFAS were 2.71 times more likely to have compliance with IFAS as compared to those who had no knowledge of IFAS [OR:2.71, 95% CI (1.33,5.54)]. Also it revealed that those women who had knowledge of anemia were 5.42 times more likely to have compliance with IFAS as compared with those who had no knowledge of anemia [OR5.42, 95% CI (1.52, 19.43)]. Furthermore, women who had received fourth visit for ANC were 1.54 times more likely to have compliance with IFAS as compared to those who had not received for ANC [OR 1.54, 95% CI (0.66, 3.58.43)]. Conclusions Our finding from this systematic review and meta-analysis shows the low case in prevalence of compliance to IFAS among pregnant women in SSA. Predictors for this includes: knowledge about anemia, knowledge about IFAS, counseling on IFAS and receiving fourth antenatal care visit were statistically correlated positively with compliance to IFAS. This demands careful appraisal of effect of prevention work for functioning policy, programs and plan nutrition intrusions for refining maternal dietary intake in gestation. Also dietary education intrusion requires to be planned to satisfy the needs of pregnant women. So we hope that the result of this study might be essential as a bridging stone for policy makers of Africa; exclusively for maternal and child health care. Finally, we recommended further studies to be conducted in the area of the study for more intensive and detailed suggestions.

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Compliance with Iron and Folic Acid Supplementation (IFAS) and associated factors among pregnant women in Sub-Saharan Africa: A systematic review and meta-analysis.

Background: Anemia is a condition where the red blood cells and their capacity to carry oxygen is not adequate to meet the physiological needs. In pregnancy iron demand is high and loss of appetite can adversely affect this condition. So, guidelines to combat anemia has provisions to provide iron in the form of iron folic acid tablets to pregnant women during antenatal and postnatal care. But compliance is still low among pregnant women who needs attention.Methods: This study included 192 postnatal mothers in Cheluvamba hospital, Mysore. Details about socio-demographic factors and number of tablets taken during antenatal period were collected using proforma. Pregnant women who had taken less than hundred tablets during antenatal period were considered non-compliant.Results: The overall compliance to iron folic tablets was 71%. The factors which were independently associated with non-compliance are nuclear family, less number of antenatal visit, tablets from private source, and anemia in current pregnancy. The reasons for non-compliance among the pregnant women who were non-compliant were inadequate counselling by health care worker followed by side effects, cost of tablets, ignorance and fear of side effects.Conclusions: Family support, adequate counselling and continuous supply of tablets free of cost would increase the compliance to tablets among pregnant women. 

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Assessment of compliance with iron-folic acid therapy during pregnancy among postnatal mothers in a tertiary care centre, Mysuru

Introduction: Nutritional adequacy is essential in ensuring the normal growth and development of the fetus. Perceived benefits will be able to strengthen pregnant women to meet optimum nutritional intake to prevent anemia. Adequacy of protein, vitamin C and iron will reduce the risk of iron deficiency anemia in pregnancy. This study aims to examine the association between perceived benefits with protein, vitamin C, and iron intake in preventing pregnancy anemia. Methods : This study used a cross-sectional design and was conducted in August-October 2017 among105 pregnant women. This study used the multistage random sampling method. The population of this study was pregnant women who had antenatal care in four Community Health Centre in Surabaya namely Jagir, MedokanAyu, SidotopoWetan, and Gundih. Results: The average daily protein intake was 76.34 (SD = 35.88) gram/day. There was a significant association between perceived benefits with protein intake (r = 0.272; p = 0.005). The average daily vitamin C intake was 90.67 (SD = 116.54) mg/day. There was no significant association between perceived benefits and vitamin C intake (r = 0.175; p = 0.074). The average daily iron intake was 64.73 (SD = 23.13) mg/day. There was a significant association between perceived benefits and iron intake (r = 0.219; p = 0.025). Conclusion: The knowledge of pregnant women about the benefits of nutrition will affect the adequacy of pregnancy nutrition. Health workers need to provide health education on the importance of nutrition for pregnant women to prevent anemia during pregnancy.

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Perceived Benefits and Intakes of Protein, Vitamin C and Iron in Preventing Anemia among Pregnant Women

Background: The prevalence of anemia in pregnant women has remained unacceptably high worldwide despite the fact that routine iron supplementation during pregnancy has been almost universally recommended to prevent maternal anemia. The major problem with iron supplementation during pregnancy is compliance. The objective of this study was to correlate iron supplements compliance among pregnant women and incidence of anemia during pregnancy. Methods: A Prospective observational study was conducted over a period of nine months from August 2015 to April 2016 in the department of obstetrics and gynecology, Bharati Hospital and Research Center, Pune. Pregnant women more than 14 weeks who attended antenatal care unit were enrolled in this study. Data for compliance was collected by two methods - first by personal interview as well as looking for the empty iron tablet strips. Pregnant women were followed till the date of delivery and maternal outcome were noted. Results: Our results show that 64% were strictly compliant, 33% with partially complaint and 3% with non-complaint with iron supplements. The mean Hemoglobin concentration of pregnant women who strictly complies with iron supplements were 11.6 g/dl where the non-compliant and partially complaint to iron supplements were 9.7 g/dl. The prevalence of anemia was found to be more in partial and non-compliant to iron supplements (13% p value <0.001). Conclusions: Anaemia, low haemoglobin levels were found more in non-complaint and partially complaint pregnant women. The findings from our study highlighted that antenatal health and a nutritional intervention program for pregnant women is needful.

Srushti Tekawade

Papers

Correlations of adherence to iron supplements and prevalence of anemia in antenatal women