Galloway Rae, Dusch Erin, Elder Leslie, Achadi Endang, Grajeda Ruben, Hurtado Elena, Favin Mike, Kanani Shubhada, Marsaban Julie, Meda Nicolas, Moore K Mona, Morison Linda, Raina Neena, Rajaratnam Jolly, Rodriquez Javier, Stephen Chitra
The World Bank, Washington, DC 20433, USA.
Soc Sci Med. 2002 Aug;55(4):529-44. doi: 10.1016/s0277-9536(01)00185-x.
The World Health Organization estimates that 58% of pregnant women in developing countries are anemic. In spite of the fact that most ministries of health in developing countries have policies to provide pregnant women with iron in a supplement form, maternal anemia prevalence has not declined significantly where large-scale programs have been evaluated. During the period 1991-98, the MotherCare Project and its partners conducted qualitative research to determine the major barriers and facilitators of iron supplementation programs for pregnant women in eight developing countries. Research results were used to develop pilot program strategies and interventions to reduce maternal anemia. Across-region results were examined and some differences were found but the similarity in the way women view anemia and react to taking iron tablets was more striking than differences encountered by region, country or ethnic group. While women frequently recognize symptoms of anemia, they do not know the clinical term for anemia. Half of women in all countries consider these symptoms to be a priority health concern that requires action and half do not. Those women who visit prenatal health services are often familiar with iron supplements, but commonly do not know why they are prescribed. Contrary to the belief that women stop taking iron tablets mainly due to negative side effects, only about one-third of women reported that they experienced negative side effects in these studies. During iron supplementation trials in five of the countries, only about one-tenth of the women stopped taking the tablets due to side effects. The major barrier to effective supplementation programs is inadequate supply. Additional barriers include inadequate counseling and distribution of iron tablets, difficult access and poor utilization of prenatal health care services, beliefs against consuming medications during pregnancy, and in most countries, fears that taking too much iron may cause too much blood or a big baby, making delivery more difficult. Facilitators include women's recognition of improved physical well being with the alleviation of symptoms of anemia, particularly fatigue, a better appetite, increased appreciation of benefits for the fetus, and subsequent increased demand for prevention and treatment of iron deficiency and anemia.
世界卫生组织估计，发展中国家58%的孕妇患有贫血症。尽管发展中国家的大多数卫生部都制定了政策，以补充剂的形式为孕妇提供铁，但在对大规模项目进行评估的地方，孕产妇贫血患病率并未显著下降。在1991年至1998年期间，母婴保健项目及其合作伙伴进行了定性研究，以确定八个发展中国家孕妇铁补充项目的主要障碍和促进因素。研究结果被用于制定试点项目策略和干预措施，以减少孕产妇贫血。对跨地区的结果进行了审查，发现了一些差异，但女性看待贫血和对服用铁剂的反应方式上的相似性比地区、国家或种族群体之间的差异更为显著。虽然女性经常认识到贫血的症状，但她们不知道贫血的临床术语。所有国家中，一半的女性认为这些症状是需要采取行动的首要健康问题，另一半则不这么认为。那些接受产前保健服务的女性通常熟悉铁补充剂，但通常不知道为什么会开这种药。与认为女性主要因副作用而停止服用铁剂的观点相反，在这些研究中，只有约三分之一的女性报告说她们经历了副作用。有效补充项目的主要障碍是供应不足。其他障碍包括铁剂的咨询和分发不足、产前保健服务难以获得和利用不佳、怀孕期间反对服用药物的观念，以及在大多数国家，担心服用过多铁剂可能导致血液过多或生出巨大儿，使分娩更加困难。促进因素包括女性认识到随着贫血症状（尤其是疲劳）的缓解，身体状况得到改善、食欲更好、对胎儿益处的认识增加，以及随后对缺铁和贫血预防与治疗的需求增加。
