A root cause analysis of sub-optimal uptake and compliance to iron and folic acid supplementation in pregnancy in 7 districts of Zambia

Abstract

Background: Iron and Folic Acid are two of the micronutrients recommended for pregnant women to support optimal maternal outcomes with regard to preventing anaemia and foetal birth defects. It is difficult to establish if women provided with iron and folic acid supplementation in Zambia benefit from it and how well it is implemented. The overall objective of this study was to determine the levels of uptake and compliance to iron and folic acid in pregnancy among women of child-bearing age in Zambia, with a focus on both supply and demand factors. Methods: A cross sectional, mixed method study was done. Data was collected in August and September 2015 from six of the 14 districts in which Scaling Up Nutrition interventions were being undertaken as well as Lusaka district. A household survey covering 402 males and females of child-bearing age, 27 key informant interviews amongst key stakeholders and 12 focus group discussions at community level were conducted. Results: Antenatal clinic attendance was almost universal (98.7%); the majority of both men (92.1%) and women (97.4%) had heard messages about iron and folic acid supplementation; the majority (96.5%) of women reported having taken iron and folic acid tablets during their last pregnancy, with 61.3% starting in the second trimester, 27.2% during the first trimester, and 7.7% in their third trimester. Eighty-five per cent (80.5%) of the women reported that they had taken all the tablets they were given with about 13.4% not taking all the tablets received. Conclusions: Root cause analysis, using both qualitative and quantitative findings, showed that the main challenges faced were long distances to health facilities and high transport costs; some women not being reached with supplementation messaging; lack of formalised and uniform training around delivery of antenatal messages across health care workers; women not attending antenatal monthly to replenish supplements; and forgetfulness to take the drugs daily. While male involvement may be a supportive factor, it sometimes hinders women from accessing antenatal services. Results showed that both uptake and compliance to iron and folic acid supplementation in pregnancy in Zambia were sub-optimal.

The effect of substance use during pregnancy on neonatal outcomes in Ethiopia: A systematic review and meta-analysis

“…After full text review of the 17 articles, 2 studies were excluded for a) not having clearly defined outcome b) poor quality. Finally, a total of 15 empirical pocket studies [ 28 , 29 , 30 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 ] were included in this systematic review and meta-analysis ( Figure 1 ).

Figure 1 PRISMA flow diagram showing the literature search results.

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“…Despite the aforementioned adverse impacts, national evidence disclosed considerable prevalence of khat [ 25 ] and alcohol use [ 35 ] during pregnancy in Ethiopia. Furthermore, there are multiple primary studies [ 28 , 29 , 30 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 ] showing the delivery of preterm, low birth weight and congenitally malformed neonates among alcohol drinkers, khat chewers, cigarette smokers and narghile users during pregnancy in the country. However, there is no pooled prior evidence regarding the effect of using these substances during pregnancy on birth outcome.…”

COVID-19 and self-care strategies for women with gestational diabetes mellitus

“…Today, technology in medical field plays an important role [ 45 ]. Up to now, the greatest potential of telemedicine has been its ability to help patients who could not be easily treated in existing clinics due to geographical limitation [ 37 ]. But in the modern world, information technology makes it possible for people to participate in their health as self-care, which means that cyberspace can serve the health system.…”

“…Also, the results of studies on self-care using telemedicine and GDM stated that telemedicine services compared to routine care were associated with reduced preterm birth [ 37 , 38 ], premature rupture of membranes, neonatal asphyxia, polyhydramnios [ 37 ], and emergency cesarean section [ 38 ]. However, there were no differences in terms of quality of life [ 39 ], mean gestational age at birth [ 40 ], mean birth weight, and hospitalized in neonatal intensive care unit (NICU), LGA [ 38 , 40 ], hyperbilirubinemia and shoulder dystocia [ 38 ] in telemedicine compared to routine care.…”

“…While telemedicine has been shown to improve the cesarean section [ 37 , 38 ], macrosomia, neonatal hypoglycemia, pregnancy complications, 2-h blood sugar, and fasting blood sugar [ 37 ], some studies have shown no difference of these parameters compared to routine care [ [38] , [39] , [40] , [41] , [42] ]. Also, the results of some studies have found the use of telemedicine to be beneficial in improving HbA1c [ 37 , 40 , 41 ] and mean blood sugar [ 42 , 43 ], however, the results of a study did not differ in HbA1c [ 39 ] and mean Blood sugar [ 38 ] compared to routine care. The results of two clinical trials indicate more satisfaction of GDM women in telemedicine technologies compared to routine care [ 38 , 44 ] and no difference in direct care costs in the two groups was reported [ 38 ].…”