坦桑尼亚北部 21889 名孕妇产前补充叶酸和铁的影响因素：基于医院的横断面研究。
Factors associated with prenatal folic acid and iron supplementation among 21,889 pregnant women in Northern Tanzania: a cross-sectional hospital-based study.
机构信息
Department of Public Health and Primary Health Care, University of Bergen, Bergen, Norway.
出版信息
BMC Public Health. 2012 Jun 26;12:481. doi: 10.1186/1471-2458-12-481.
BACKGROUND
Folate and iron deficiency during pregnancy are risk factors for anaemia, preterm delivery, and low birth weight, and may contribute to poor neonatal health and increased maternal mortality. The World Health Organization recommends supplementation of folic acid (FA) and iron for all pregnant women at risk of malnutrition to prevent anaemia. We assessed the use of prenatal folic acid and iron supplementation among women in a geographical area with a high prevalence of anaemia, in relation to socio-demographic, morbidity and health services utilization factors.
METHODS
We analysed a cohort of 21,889 women who delivered at Kilimanjaro Christian Medical Centre (KCMC), Moshi, Tanzania, between 1999 and 2008. Logistic regression models were used to describe patterns of reported intake of prenatal FA and iron supplements.
RESULTS
Prenatal intake of FA and iron supplements was reported by 17.2% and 22.3% of pregnant women, respectively. Sixteen percent of women reported intake of both FA and iron. Factors positively associated with FA supplementation were advanced maternal age (OR = 1.17, 1.02-1.34), unknown HIV status (OR = 1.54, 1.42-1.67), a diagnosis of anaemia during pregnancy (OR = 12.03, 9.66-14.98) and indicators of lower socioeconomic status. Women were less likely to take these supplements if they reported having had a malaria episode before (OR = 0.57, 0.53-0.62) or during pregnancy (OR = 0.45, 0.41-0.51), reported having contracted other infectious diseases (OR = 0.45, 0.42-0.49), were multiparous (OR = 0.73, 0.66-0.80), had preeclampsia/eclampsia (OR = 0.48, 0.38-0.61), or other diseases (OR = 0.55, 0.44-0.69) during pregnancy. Similar patterns of association emerged when iron supplementation alone and supplementation with both iron and FA were evaluated.
CONCLUSIONS
FA and iron supplementation are low among pregnant women in Northern Tanzania, in particular among women with co-morbidities before or during pregnancy. Attempts should be made to increase supplementation both in general and among women with pregnancy complications.
背景
妊娠期间叶酸和铁缺乏是贫血、早产和低出生体重的风险因素，可能导致新生儿健康状况不佳和产妇死亡率增加。世界卫生组织建议所有有营养不良风险的孕妇补充叶酸（FA）和铁，以预防贫血。我们评估了在一个贫血高发地区，与社会人口统计学、发病率和卫生服务利用因素相关的孕妇使用产前叶酸和铁补充剂的情况。
方法
我们分析了 1999 年至 2008 年在坦桑尼亚莫希的基督城医疗中心（KCMC）分娩的 21889 名妇女的队列。使用逻辑回归模型描述报告的产前 FA 和铁补充剂摄入模式。
结果
分别有 17.2%和 22.3%的孕妇报告了产前 FA 和铁补充剂的摄入。16%的妇女报告同时摄入了 FA 和铁。与 FA 补充剂摄入呈正相关的因素包括：高龄产妇（OR=1.17，1.02-1.34）、HIV 状态未知（OR=1.54，1.42-1.67）、妊娠期间贫血诊断（OR=12.03，9.66-14.98）和较低社会经济地位的指标。如果妇女在妊娠前（OR=0.57，0.53-0.62）或妊娠期间（OR=0.45，0.41-0.51）报告有疟疾发作，或报告有其他传染病（OR=0.45，0.42-0.49）、多胎产（OR=0.73，0.66-0.80）、子痫前期/子痫（OR=0.48，0.38-0.61）或妊娠期间有其他疾病（OR=0.55，0.44-0.69），则不太可能服用这些补充剂。当单独评估铁补充剂和同时补充铁和 FA 时，也出现了类似的关联模式。
结论
在坦桑尼亚北部，孕妇中 FA 和铁的补充率很低，特别是在妊娠前或妊娠期间有合并症的妇女中。应努力增加一般人群和妊娠并发症妇女的补充剂。
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