<p>Effect of Integrated Pictorial Handbook Education and Counseling on Improving Anemia Status, Knowledge, Food Intake, and Iron Tablet Compliance Among Anemic Pregnant Women in Indonesia: A Quasi-Experimental Study</p>

Abstract

Province of Aceh, IndonesiaPurpose: To determine the effect of individual education through a pictorial handbook on anemia in conjunction with counseling on improving hemoglobin and hematocrit level, birth weight, knowledge, iron-rich food and iron-folic acid (IFA) intake. Patients and Methods: The study developed a pictorial handbook that was conceptualized based on the Health Belief Model and adjusted to some cultural and local contexts. A quasiexperimental pre-test-post-test control group design was used, purposefully conducted between two homogenous municipalities, each having a rate of anemic pregnancy that was 40% or greater. The sample consists of 140 anemic pregnant women randomly allocated via lottery into two groups; the intervention group (n=70), which received two home visits-one for education and another for a counseling session, and control group (n=70), which received routine antenatal care. A chi-square test and a Mann-Whitney U-test were conducted to compare the baseline socio-demographics. An analysis of covariance (ANCOVA), controlling some possible confounders, was performed to analyze the effect of intervention. Results: The post-test means of hemoglobin F (1, 132) = 122, p-value <0.001, and hematocrit levels F (1, 132) = 373, p-value <0.001, were significantly different and higher in the intervention group compared to the control group. Similar results were found in knowledge, food frequency score, number of IFA intake (with p-value <0.001), birth weight and daily iron intake from food (with p-value <0.05). The intervention had a particularly large effect on food frequency score and number of IFA intake, and medium effect on hemoglobin and hematocrit levels. Conclusion: Individual education through a pictorial handbook on anemia in conjunction with the counseling intervention program had a positive impact on hemoglobin and hematocrit levels for anemic pregnant women in their third trimester of pregnancy.

<p>A Response to “Effect of Integrated Pictorial Handbook Education and Counseling on Improving Anemia Status, Knowledge, Food Intake, and Iron Tablet Compliance Among Anemic Pregnant Women in Indonesia: A Quasi-Experimental Study” [Letter]</p>

“…

We have carefully studied the article published under the title "Effect of Integrated Pictorial Handbook Education and Counseling on Improving Anemia Status, Knowledge, Food Intake, and Iron Tablet Compliance Among Anemic Pregnant Women in Indonesia: A Quasi-Experimental Study". 1 The results of this study had proven that counseling using a handbook that had been prepared by the researchers was really useful to increase knowledge, maintain adequate nutrition and prevent anemia in pregnant women, which was characterized by increased levels of hemoglobin and hematocrit. 1

…”

“…1 The results of this study had proven that counseling using a handbook that had been prepared by the researchers was really useful to increase knowledge, maintain adequate nutrition and prevent anemia in pregnant women, which was characterized by increased levels of hemoglobin and hematocrit. 1…”

Interventions to increase adherence to micronutrient supplementation during pregnancy: a systematic review

“…All studies were conducted in countries with lower-middle or upper-middle income economies. Over half of the studies were conducted in Asia (Nepal, 26 India, [27][28][29][30][31][32][33] Bangladesh, 34 Indonesia, 25,[35][36][37][38][39] and Thailand 40 ), with only two studies conducted in Africa (Senegal 41 and Kenya 42 ) and four conducted in the Middle East (Jordan 43 and Iran [44][45][46].…”

“…Five studies were conducted in anemic pregnant women. 29,30,37,39,43 As per our inclusion criteria, adherence was assessed in all studies (Tables 2 and 3). Nevertheless, the method used to measure adherence differed significantly between the studies, including prevalidated scales (e.g., Morisky Medication Adherence Scale-8 (MMAS-8) questionnaire), self-reported recall, supplement compliance documentation cards, direct observation, and pill counting (Tables 2 and 3).…”

“…Adverse gastrointestinal symptoms and the secondary outcomes of interest were reported by fewer studies. Adverse effects were only reported in four studies; 28,35,37,42 hemoglobin levels were assessed in 13 studies; 26,[28][29][30][31][32]35,36,38,39,41,43,46 1.9 (-0.9, 4.8), P = 0.186 Prevalence (%) in the most marginalized women: I1: pretest 9, posttest 20.9 C: pretest 3, posttest 7.5 Adjusted DID: 7.3 (0.5, 4.1), P = 0.036 Kamau (2020) 42 Self (20.18), C: -2.14 (6.93), P = 0.42 NOTE: When available, outcome results are highlighted in green if differences (within-group and between-groups) are statistically significant, and in red when not statistically significant.…”