Supports and Barriers Regarding The Iron-Folic Acid Supplementation Adherence Level in Anemic Pregnant Women: Indonesian’s Perspective
Abstract
Anemia is a worldwide public health issue that affects various groups in low, middle, and high-income nations. Anemia is linked to pregnancy and is influencing poor cognitive and motor development outcomes in children. A recommended intervention to reduce anemia prevalence during pregnancy is the universal administration of Iron-Folic Acid (IFA) supplements. This study investigated supports and barriers regarding iron-folic acid supplementation adherence levels in pregnant women recorded in public health centers in Malang, Indonesia. This research was conducted using qualitative methods with in-depth interviews using semi-structured open-ended questions from July to September 2023. Twenty-five participants from four public health centers was included. The interview guide's content was developed using World Health Organization’s framework as well as other pertinent themes. Data analysis was processed from verbal record transcription, generating the codes into the outcomes. Five main themes with a total of eleven subthemes were highlighted from interview process. These themes was further classified into barriers and supports. Side effect, forgetfulness, boredom, laziness, and insufficient understanding of disease recorded as barriers. In contrast, husband and family support, health care team motivation, affordability of access, knowledge and education background included in supports. These findings enlighten the barriers encountered by the pregnant women in IFA supplementation adherence. However, the effectiveness of treating anemia during pregnancy might be influenced by fundamental elements that support IFA supplementation adherence. Therefore, to tackle the this issue, the pregnant women requires a proper therapy and all key points mentioned in support group must be applied.
References
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33. Solomon Y, Sema A, Menberu T. Adherence and Associated Factors to Iron and Folic Acid Supplementation Among Pregnant Women Attending Antenatal Care in Public Hospitals of Dire Dawa, Eastern Ethiopia. European Journal of Midwifery. 2021;5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8386124/
34. Gebremariam AD, Tiruneh SA, Abate BA, Engidaw MT, Asnakew DT. Adherence to Iron with Folic Acid Supplementation And its Associated Factors among Pregnant Women Attending Antenatal Care Follow Up at Debre Tabor General Hospital, Ethiopia, 2017. PLoS One. 2019;14(1). https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0210086
35. Agegnehu G, Atenafu A, Dagne H, Dagnew B. Adherence to Iron and Folic Acid Supplement and Its Associated Factors among Antenatal Care Attendant Mothers in Lay Armachiho Health Centers, Northwest, Ethiopia, 2017. Nottola SA, editor. International Journal of Reproductive Medicine. 2019;2019:5863737. https://www.hindawi.com/journals/ijrmed/2019/5863737/
2. WHO. Global Anemia Reduction Efforts among Women of Reproductive Age: Impact, Achievement of Targets, and the Way Forward for Optimizing Efforts. Geneva, Switzerland: World Health Organization. 2020. https:%0A//www.who.int/publications/i/item/9789240012202
3. Balarajan Y, Ramakrishnan U, Ozaltin E, Shankar AH, Subramanian S V. Anaemia in Low-Income and Middle-Income Countries. Lancet (London, England). 2011;378(9809): 2123–2135. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(10)62304-5/abstract
4. Kassebaum NJ, Collaborators GBD 2013 A. The Global Burden of Anemia. Hematology/Oncology Clinics of North America. 2016;30(2):247–308. https://observatorio.fm.usp.br/handle/OPI/26259
5. Khani Jeihooni A, Rakhshani T, Harsini PA, Layeghiasl M. Effect of Educational Program Based on Theory of Planned Behavior on Promoting Nutritional Behaviors Preventing Anemia in A Sample of Iranian Pregnant Women. BMC Public Health. 2021;21:1–9. https://link.springer.com/article/10.1186/s12889-021-12270-x
6. Kapil U, Kapil R, Gupta A. Prevention and Control of Anemia Amongst Children and Adolescents: Theory and Practice in India. Indian Journal of Pediatrics. 2019;86:523–531. https://link.springer.com/article/10.1007/s12098-019-02932-5
7. Birhanu TM, Birarra MK, Mekonnen FA. Compliance To Iron and Folic Acid Supplementation in Pregnancy, Northwest Ethiopia. BMC Research Notes 2018;11:1–5. https://link.springer.com/article/10.1186/s13104-018-3433-3
8. Abd Rahman R, Idris IB, Md Isa Z, Abd Rahman R. The Effectiveness of A Theory-Based Intervention Program For Pregnant Women With Anemia: A Randomized Control Trial. PLoS One. 2022;17(12). https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0278192
9. Kusumawardani N, Darmawan E, Suprapti S, Dwinta E, Estiningsih D. Pharmacist Counselling Can Change Adherence to Iron Supplementation and Physical Activity Lifestyle of Anaemic Pregnant Women in Yogyakarta. In: 2nd International Conference on Contemporary Science and Clinical Pharmacy 2021 (ICCSCP 2021). Atlantis Press; 2021:157–170.
10. Atmadani RN, Irham LM, Perwitasari DA, Akrom A, Urbayatun S. Adherence to Iron Supplementation Among Anemic Pregnant Women During 1964-2022: A Bibliometric Analysis. Public Health of Indonesia. 2023;9(1):1–12. https://doi.org/10.36685/phi.v9i1.647
11. Dalal M, Goyal R, Nanda S, Dahiya P, Dahiya K, Madan S. Oral Versus Intravenous Iron for Treatment of Iron Deficiency Anaemia in Pregnancy: A Randomized Controlled Trial. Indian Journal of Public Health Research & Development. 2018;9(6):1–6. https://www.scopus.com/inward/record.uri?eid=2-s2.0-85048969659&doi=10.5958%2F0976-5506.2018.00513.2&partnerID=40&md5=db500b49f7e03e339b286d8a6b2486a3
12. Smitha MV, Indumathi P, Parichha S, Kullu S, Roy S, Gurjar S, et al. Compliance with Iron-Folic Acid Supplementation, Associated Factors, and Barriers Among Postpartum Women in Eastern India. Human Nutrition & Metabolism. 2024;35:200237. https://www.sciencedirect.com/science/article/pii/S2666149723000543
13. Siekmans K, Roche M, Kung’u JK, Desrochers RE, De-Regil LM. Barriers and Enablers For Iron Folic Acid (IFA) Supplementation in Pregnant Women. Maternal & Child Nutrition. 2018;14:e12532.
https://onlinelibrary.wiley.com/doi/full/10.1111/mcn.12532
14. Fouelifack FY, Sama JD, Sone CE. Assessment of Adherence to Iron Supplementation among Pregnant Women in the Yaounde Gynaeco-Obstetric and Paediatric Hospital. The Pan African Medical Journal. 2019;34.
https://www.ajol.info/index.php/pamj/article/view/212238
15. Demis A, Geda B, Alemayehu T, Abebe H. Iron and Folic Acid Supplementation Adherence Among Pregnant Women Attending Antenatal Care in North Wollo Zone Northern Ethiopia: Institution Based Cross-Sectional Study. BMC Research Notes. 2019;12(1):1–7. https://link.springer.com/article/10.1186/s13104-019-4142-2
16. Busetto L, Wick W, Gumbinger C. How To Use and Assess Qualitative Research Methods. Neurological Research and Practice. 2020;2:1–10. https://link.springer.com/article/10.1186/s42466-020-00059-z
17. Wahyuni S. Qualitative Research Method: Theory and Practice. Third. Jakarta: Salemba Empat; 2019. 278
18. WHO. Adherence to long-term therapies: evidence for action: 2003. Geneva, Switzerland: World Health Organization.
19. Ramayanti E, Sulistyoningtyas S. The Factors Affecting the Behavior of Pregnant Women in Conducting Triple Elimination Examinations During the Pandemic at Nani Rusnani Maternity Clinic. Menara Journal of Health Science. 2022;1(4):324–336. https://doi:10.35335/midwifery.v10i5.93
20. Molla T, Guadu T, Muhammad EA, Hunegnaw MT. Factors Associated with Adherence to Iron Folate Supplementation Among Pregnant Women in West Dembia District, Northwest Ethiopia: A Cross Sectional Study. BMC Research Notes. 2019;12(1):1–6. https://bmcresnotes.biomedcentral.com/articles/10.1186/s13104-019-4045-2
21. Turawa E, Awotiwon O, Dhansay MA, Cois A, Labadarios D, Bradshaw D, et al. Prevalence of Anaemia, Iron Deficiency, and Iron Deficiency Anaemia in Women of Reproductive Age and Children Under 5 Years of Age In South Africa (1997–2021): A Systematic Review. International Journal of Environmental Research and Public Health. 2021;18(23):12799. https://www.mdpi.com/1660-4601/18/23/12799
22. Silubonde TM, Draper CE, Baumgartner J, Ware LJ, Smuts CM, Norris SA. Barriers and Facilitators of Micronutrient Supplementation Among Non-Pregnant Women of Reproductive Age in Johannesburg, South Africa. PLOS Global Public Health. 2022;2(11). https://journals.plos.org/globalpublichealth/article?id=10.1371/journal.pgph.0001310
23. Lutfita SM, Pratiwi PY. The Relationship Between Knowledge with Compliance of Fe Tablet Consumption in Third Trimester Pregnant Women at The Jambukulon Public Health Center. Medical Journal of Nusantara 2023;2(1):32–37. https://doi.org/10.55080/mjn.v2i1.126
24. Desta M, Kassie B, Chanie H, Mulugeta H, Yirga T, Temesgen H, et al. Adherence of Iron and Folic Acid Supplementation and Determinants among Pregnant Women in Ethiopia: A Systematic Review and Meta-Analysis. Reproductive Health. 2019;16(1). https://reproductive-health-journal.biomedcentral.com/articles/10.1186/s12978-019-0848-9
25. Bahati F, Kairu-Wanyoike S, Nzioki JM. Adherence to Iron and Folic Acid Supplementation During Pregnancy among Postnatal Mothers Seeking Maternal and Child Healthcare at Kakamega Level 5 Hospital in Kenya: A Cross-Sectional Study. Wellcome Open Research. 2021;6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8366300/
26. Sasono HA, Husna I, Zulfian Z, Mulyani W. Relationship of Education Level and Anemia Events in Pregnant Women in Some Regions of Indonesia. Jurnal Medika Malahayati. 2021;5(1):59–66. https://doi.org/10.33024/jmm.v5i1.3891
27. Yanti LM, Mahardita MU, Hidayati L, Firmansyah F, Warajati S, Isnaeni I. Hubungan Tingkat Pendidikan, Pengetahuan Tentang Anemia, Dukungan Keluarga dengan Kepatuhan Ibu Hamil Minum TTD. In: Prosiding University Research Colloquium. 2023. 974–982. http://repository.urecol.org/index.php/proceeding/article/view/2527
28. Bakhtiar R, Muladi Y, Tamaya A, Utari A, Yuliana R, Ariyanti W. Hubungan Pengetahuan dan Kepatuhan Ibu Hamil Anemia dalam Mengkonsumsi Tablet Tambah Darah di Wilayah Kerja Puskesmas Lempake Kota Samarinda. Jurnal Kedokteran Mulawarman. 2021;8(3):78–88. https://e-journals.unmul.ac.id/index.php/JKM/article/view/6514
29. Maryam S. Analisis Riwayat Tablet Tambah Darah pada Ibu Hamil dengan Anemia di Indonesia (Data Riskesdas 2018). Kebidanan. 2020;10(2):1–8. https://journal.unita.ac.id/index.php/bidan/article/view/404
30. Lavanya P, Jayalakshmy R, Rajaa S, Mahalakshmy T. Adherence to Iron and Folic Acid Supplementation among Antenatal Mothers Attending a Tertiary Care Center, Puducherry: A Mixed-Methods Study. J Fam Med Prim CARE. 2020;9(10):5205–5211. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7773120/
31. Kamau MW, Mirie W, Kimani S. Compliance with Iron and Folic Acid Supplementation (IFAS) and Associated Factors Among Pregnant Women: Results from A Cross-Sectional Study in Kiambu County, Kenya. BMC Public Health. 2018;18. https://link.springer.com/article/10.1186/s12889-018-5437-2
32. Claeson M, Folger P. Health Issues of the UN Millennium Development Goals. In: Heggenhougen HK (Kris) BT-IE of PH, editor. Oxford: Academic Press; 2008. 197–204.
33. Solomon Y, Sema A, Menberu T. Adherence and Associated Factors to Iron and Folic Acid Supplementation Among Pregnant Women Attending Antenatal Care in Public Hospitals of Dire Dawa, Eastern Ethiopia. European Journal of Midwifery. 2021;5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8386124/
34. Gebremariam AD, Tiruneh SA, Abate BA, Engidaw MT, Asnakew DT. Adherence to Iron with Folic Acid Supplementation And its Associated Factors among Pregnant Women Attending Antenatal Care Follow Up at Debre Tabor General Hospital, Ethiopia, 2017. PLoS One. 2019;14(1). https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0210086
35. Agegnehu G, Atenafu A, Dagne H, Dagnew B. Adherence to Iron and Folic Acid Supplement and Its Associated Factors among Antenatal Care Attendant Mothers in Lay Armachiho Health Centers, Northwest, Ethiopia, 2017. Nottola SA, editor. International Journal of Reproductive Medicine. 2019;2019:5863737. https://www.hindawi.com/journals/ijrmed/2019/5863737/
Authors
Atmadani, R. N., Akrom, A., Ananda, D., Saputri, L. Y., Puspitasari, A. A. ., & Urbayatun, S. (2024). Supports and Barriers Regarding The Iron-Folic Acid Supplementation Adherence Level in Anemic Pregnant Women: Indonesian’s Perspective. Media Kesehatan Masyarakat Indonesia, 20(2), 46-56. https://doi.org/10.30597/mkmi.v20i2.32569
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