Martin Stephanie L, Seim Gretchen L, Wawire Salome, Chapleau Gina M, Young Sera L, Dickin Katherine L
Program in International Nutrition, Division of Nutritional Sciences, Cornell University, Ithaca, New York, USA.
Department of Nutritional Sciences, University of Wisconsin-Madison, Madison, Wisconsin, USA.
Matern Child Nutr. 2017 Jan;13(1). doi: 10.1111/mcn.12233. Epub 2016 Feb 22.
The World Health Organization now recommends integrating calcium supplements into antenatal micronutrient supplementation programmes to prevent pre-eclampsia, a leading cause of maternal mortality. As countries consider integrating calcium supplementation into antenatal care (ANC), it is important to identify context-specific barriers and facilitators to delivery and adherence. Such insights can be gained from women's and health workers' experiences with iron and folic acid (IFA) supplements. We conducted in-depth interviews with 22 pregnant and post-partum women and 20 community-based and facility-based health workers in Kenya to inform a calcium and IFA supplementation programme. Interviews assessed awareness of anaemia, pre-eclampsia and eclampsia; ANC attendance; and barriers and facilitators to IFA supplement delivery and adherence. We analyzed interviews inductively using the constant comparative method. Women and health workers identified poor diet quality in pregnancy as a major health concern. Neither women nor health workers identified pre-eclampsia, eclampsia, anaemia or related symptoms as serious health threats. Women and community-based health workers were unfamiliar with pre-eclampsia and eclampsia and considered anaemia symptoms normal. Most women had not received IFA supplements, and those who had received insufficient amounts and little information about supplement benefits. We then developed a multi-level (health facility, community, household and individual) behaviour change strategy to promote antenatal calcium and IFA supplementation. Formative research is an essential first step in guiding implementation of antenatal calcium supplementation programmes to reduce pre-eclampsia. Because evidence on how to implement successful calcium supplementation programmes is limited, experiences with antenatal IFA supplementation can be used to guide programme development.
世界卫生组织现建议将钙补充剂纳入产前微量营养素补充计划，以预防先兆子痫，这是孕产妇死亡的主要原因。随着各国考虑将钙补充剂纳入产前保健（ANC），识别特定背景下影响提供和坚持服用钙补充剂的障碍和促进因素非常重要。此类见解可从妇女和卫生工作者服用铁和叶酸（IFA）补充剂的经历中获得。我们对肯尼亚22名孕妇和产后妇女以及20名社区和医疗机构的卫生工作者进行了深入访谈，以为一项钙和IFA补充计划提供信息。访谈评估了对贫血、先兆子痫和子痫的认知；产前保健的就诊情况；以及IFA补充剂的提供和坚持服用的障碍与促进因素。我们采用持续比较法对访谈进行归纳分析。妇女和卫生工作者将孕期不良饮食质量视为主要健康问题。妇女和卫生工作者均未将先兆子痫、子痫、贫血或相关症状视为严重健康威胁。妇女和社区卫生工作者不熟悉先兆子痫和子痫，认为贫血症状正常。大多数妇女未服用过IFA补充剂，而那些服用过的妇女，所获剂量不足且对补充剂益处了解甚少。然后，我们制定了一项多层次（医疗机构、社区、家庭和个人）行为改变策略，以促进产前钙和IFA补充。形成性研究是指导实施产前钙补充计划以减少先兆子痫的关键第一步。由于关于如何实施成功的钙补充计划的证据有限，产前IFA补充的经验可用于指导计划制定。
