埃塞俄比亚孕妇在推荐时期内铁-叶酸摄入量的个体和社区层面决定因素：一项多层次分析。
Individual and community-level determinants of Iron-Folic Acid Intake for the recommended period among pregnant women in Ethiopia: A multilevel analysis.
作者信息
Tadesse Abay Woday, Aychiluhm Setognal Birara, Mare Kusse Urmale
机构信息
Samara University, College of Medicine and Health Sciences, Department of Public Health, Samara, Ethiopia.
Armauer Hansen Research Institute, Addis Ababa, Ethiopia.
出版信息
Heliyon. 2021 Jul 9;7(7):e07521. doi: 10.1016/j.heliyon.2021.e07521. eCollection 2021 Jul.
BACKGROUND
Iron-folic acid (IFA) intake for the recommended period during pregnancy reduces the risk of anemia and congenital anomalies. However, IFA intake for the recommended period is still very low in low-income countries including Ethiopia. Thus, the aim of this study was to assess both individual-and community-level determinants of IFA intake for the recommended period among pregnant women in Ethiopia.
METHODS
Data were retrieved from the Demographic and Health Survey program's official database website (http://dhsprogram.com). A two-stage stratified cluster sampling technique was employed to conduct the 2016 Ethiopian Demographic and Health Survey. A sample of 3088 pregnant women who had received at least one dose of IFA in Ethiopia were included in this study. A multivariable multilevel logistic regression analysis model was fitted to identify the determinants of IFA intake below the recommended period [< 90 days] during pregnancy. Akaike's Information Criterion (AIC) was used during the model selection procedure.
RESULTS
This study revealed that 87.6% [95% CI; 86.3%, 88.6%] of the women took IFA below the recommended period during the index pregnancy. After adjusting for the covariates: living in rural areas [AOR = 1.74: 95% CI 1.37, 2.50], and women's illiterate proportion [AOR = 1.43: 95% CI 1.06, 1.70] were community level factors. Whereas, primary education level [AOR = 0.63: 95% CI 0.40, 0.78], poorer wealth index [AOR = 1.53: 95% CI 1.08, 3.09], 4 + antenatal care visits [AOR = 0.43: 95% CI 0.31, 0.69], and receive nutritional counseling during pregnancy [AOR = 0.63: 95% CI 0.37, 0.84] were the individual-level factors of IFA intake below the recommended period during pregnancy.
CONCLUSIONS
In this study, nearly nine out of ten pregnant women did not take IFA for the recommended period. Thus, promoting recommended ANC visits, enhancing the quality of nutritional counseling, strengthening the expansion of media, and educate rural women towards the importance of optimal intake of IFA during pregnancy. Besides, the policymakers should design essential strategies based on identified barriers to improve the IFA intake for the recommended period.
背景
孕期在推荐时长内摄入铁叶酸（IFA）可降低贫血和先天性异常的风险。然而，在包括埃塞俄比亚在内的低收入国家，孕期在推荐时长内摄入IFA的情况仍然非常低。因此，本研究的目的是评估埃塞俄比亚孕妇在推荐时长内摄入IFA的个体和社区层面的决定因素。
方法
数据从人口与健康调查项目的官方数据库网站（http://dhsprogram.com）获取。采用两阶段分层整群抽样技术开展2016年埃塞俄比亚人口与健康调查。本研究纳入了埃塞俄比亚3088名至少接受过一剂IFA的孕妇样本。采用多变量多水平逻辑回归分析模型来确定孕期在推荐时长以下[<90天]摄入IFA的决定因素。在模型选择过程中使用赤池信息准则（AIC）。
结果
本研究显示，87.6%[95%置信区间；86.3%，88.6%]的女性在本次索引孕期内摄入IFA的时长低于推荐时长。在对协变量进行调整后：生活在农村地区[AOR = 1.74：95%置信区间1.37，2.50]以及女性文盲比例[AOR = 1.43：95%置信区间1.06，1.70]是社区层面因素。而小学教育水平[AOR = 0.63：95%置信区间0.40，0.78]、较贫困的财富指数[AOR = 1.53：95%置信区间1.08，3.09]、4次及以上产前检查[AOR = 0.43：95%置信区间0.31，0.69]以及孕期接受营养咨询[AOR = 0.63：95%置信区间0.37，0.84]是孕期在推荐时长以下摄入IFA的个体层面因素。
结论
在本研究中，近十分之九的孕妇在推荐时长内未摄入IFA。因此，应促进推荐的产前检查就诊，提高营养咨询质量，加强媒体宣传，并教育农村妇女认识孕期最佳摄入IFA的重要性。此外，政策制定者应根据已确定的障碍设计基本策略，以提高在推荐时长内的IFA摄入量。
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