A qualitative assessment of barriers to iron and folic acid supplementation among pregnant women in Botswana.

Autor: Kebaabetswe P; Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana., Diseko M; Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana., Zash R; Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana.; Beth Israel Deaconess Medical Center, Boston, USA., Mayondi G; Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana., Mabuta J; Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana., Mmalane M; Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana., Makhema J; Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana., Lockman S; Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana.; Harvard T.H. Chan School of Public Health, Boston, USA.; Brigham and Women's Hospital, Boston, USA., Moeng L; Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana.; Beth Israel Deaconess Medical Center, Boston, USA., Lowenthal E; Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, USA., Shapiro R; Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana.; Harvard T.H. Chan School of Public Health, Boston, USA., Caniglia EC; Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana. ellen.caniglia@pennmedicine.upenn.edu.; Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, USA. ellen.caniglia@pennmedicine.upenn.edu.
Jazyk: angličtina
Zdroj: BMC public health [BMC Public Health] 2024 Dec 04; Vol. 24 (1), pp. 3369. Date of Electronic Publication: 2024 Dec 04.
DOI: 10.1186/s12889-024-20685-5
Abstrakt: Background: Antenatal iron and folic acid (IFA) supplementation remains an effective strategy in the prevention of maternal anemia and low birthweight and is universally recommended by WHO. However, uptake of IFA has varied globally due to challenges with acceptability, supply and distribution, counselling and knowledge, and access to health services. In Botswana, nearly one-third of pregnant women engaged in antenatal care do not receive IFA, despite it being standard of care. The objectives of this study were to assess knowledge of and barriers and facilitators to IFA supplementation before and during pregnancy.
Methods: We conducted qualitative interviews with two key stakeholder groups at two different levels-the individual level (pregnant women) and the service delivery level (health care providers). Here, we present results from interviews with pregnant women at two representative antenatal clinic sites in Botswana in 2022.
Results: Pregnant women were motivated to be healthy and were knowledgeable about the benefits of supplementation during pregnancy to mothers and their infants; however, women knew more about the benefits of iron than folic acid. Most women were in favor of receiving IFA supplementation prior to pregnancy and receiving fortified foods. Several key barriers were identified: lack of supplement availability in the clinics, poverty, side effects, number of tablets, and adherence. Approaches to overcome these barriers included improving supplement availability, improving health education, increasing supply of nutritious and fortified foods, backyard gardens, and increasing family and monetary support.
Conclusions: Our study identified a need to 1) increase the availability of supplementation at antenatal clinics and 2) improve education regarding supplementation to include information about the benefits of folic acid and other micronutrients. Implementation research is needed to ascertain whether increasing supply and improving education could increase utilization of supplementation during pregnancy, with the ultimate goal of improving maternal and infant outcomes.
Competing Interests: Declarations. Ethics approval and consent to participate: The study was approved by the Institutional Review Board at the University of Pennsylvania Perelman School of Medicine and by the Human Research Development Council (HRDC) in Botswana. All personnel involved in the conduct of this study had completed Human Subjects Protection Training. The study coordinator made sure that, throughout the study, all relevant ethical principles for conducting interviews with the relevant stakeholders were observed. Key ethical principles observed by the research team included being sensitive to beliefs, manners, and customs of participants, acting with integrity and honesty with participants, ensuring a respectful communication and contact with participants, protecting the anonymity and confidentiality of individual information, and obtaining informed consent from everyone interviewed. Participants were given the liberty to not answer questions they did not feel comfortable answering and could withdraw their participation at any point during the interview. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.
(© 2024. The Author(s).)
Databáze: MEDLINE
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