“How Often? How Much? Where From?” Knowledge, Attitudes, and Practices of Mothers and Health Workers to Iron Supplementation Program for Children Under Five in Rural Tamil Nadu, South India

Abstract

Iron deficiency anemia (IDA) affects 70% of under-5 children in India. The primary prevention strategy is regular iron supplementation. Little is known about what helps families adhere to daily iron supplementation. Our study explored the knowledge, attitudes, and practices of mothers and village health workers (VHWs) involved in a community health program in one hill district of Tamil Nadu. We conducted 30 semistructured interviews and 3 group discussions involving mothers, VHWs, and community stakeholders. Knowledge of IDA was widespread, yet no children were receiving the iron supplementation as recommended. The main determinants to adherence included the perception of its need, the ease of access, and the activity of VHWs. Preventive care requiring daily supplements is challenging. Our study suggests that increasing community awareness of mild anemia, simplifying dosage instructions, and further strengthening the supportive environment for VHWs would help in reducing the prevalence of IDA.

Strategies to address anaemia among pregnant and lactating women in India: a formative research study

“…However, in their current form, IFA supplements produce side effects that hinder adherence. Consistent with other research (10,11,46) , our study underscored the challenges of promoting a treatment that can have multiple side effects for women who are already going through a period of intense biological changes during pregnancy.…”

“…poor adherence can be attributed to supplement side effects; low literacy; unclear instructions that may result in improper dosage (10) ; constipation, gastritis and vomiting among pregnant and lactating women; forgetfulness and misunderstanding the need to continue taking supplements throughout pregnancy (11)(12)(13) . Other low-adherence factors include lack of awareness of anaemia symptoms and not understanding the consequences or the benefits of prevention, low agency within one's household, beliefs about pill consumption during pregnancy, poor utilisation of timeappropriate antenatal services and insufficient counselling by healthcare providers (14,15) .…”

Individual and Facility-Level Determinants of Iron and Folic Acid Receipt and Adequate Consumption among Pregnant Women in Rural Bihar, India

“…Women not understanding the correct dosage and forgetfulness were cited by Seck et al as significant barriers to IFA adherence[ 20 ]. A qualitative study in Tamil Nadu also noted the motivation of health workers and perceived need by the community as important determinants of antenatal iron supplementation compliance[ 54 ]. These aspects of counseling effectiveness and community awareness were not assessed in our analysis.…”

Associations Between Maternal Nutrition Knowledge, Attitude, and Practice and 25-Hydroxyvitamin D Levels and Rickets in Children in Xinjiang Province, People’s Republic of China

“…In particular, among healthy or recovered children, mothers lack awareness of risk factors for nutrition disease and do not actively seek to acquire skills and knowledge that can help them prevent disease development. 26 During pregnancy or early childbirth, mothers may not be aware of nutrition problems or rickets in children, but interventions can be performed when such issues occur. Considering that rickets can occur during or after pregnancy, improving maternal nutritional KAP status can facilitate improvement in nutrition, thereby reducing the occurrence of rickets.…”