Silubonde Takana M, Draper Catherine E, Baumgartner Jeannine, Ware Lisa J, Smuts Cornelius M, Norris Shane A
Centre of Excellence for Nutrition, Faculty of Health Sciences, North-West University, Potchefstroom, South Africa.
SAMRC/Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
PLOS Glob Public Health. 2022 Nov 30;2(11):e0001310. doi: 10.1371/journal.pgph.0001310. eCollection 2022.
The prevalence of anaemia among South African women of reproductive age (WRA) remains high at 39%. Multiple micronutrient supplementation (MMS) may be an effective strategy in the prevention and management of anaemia. Our aim was to understand facilitators and barriers to preconception MMS adherence and to explore perceptions and beliefs of MMS in the prevention and treatment of anaemia among non-pregnant WRA. This qualitative study was embedded in a preconception MMS intervention trial of WRA and was conducted in two phases. Phase one assessed the barriers and facilitators of MMS adherence. Individual interviews were conducted with the community health workers (n = 7) administering MMS, and with non-pregnant WRA (n = 25) participating in the trial. Phase two included four focus groups with participating WRA (n = 26), which further explored participants' perceptions and beliefs of MMS provision and adherence, and strategies to improve adherence. The reported facilitators to supplementation were family support, interaction with the community health workers, easy access to MMS, and experienced benefits of MMS. Barriers to preconception supplementation included the lack of family support, the link of supplements to antenatal care, and the perceived lack of benefits of MMS. Participants reported negative associations of supplements with medication, individual and societal stigma around medication and challenges around the supplementation schedule. For successful preconception MMS interventions, young women, their families, and communities need to be convinced of the value of supplementation. Public health interventions utilising preconception supplementation will require specialised training for health care providers, targeted counselling materials and community household support.
南非育龄妇女（WRA）的贫血患病率仍然很高，为39%。多种微量营养素补充剂（MMS）可能是预防和管理贫血的有效策略。我们的目的是了解孕前MMS依从性的促进因素和障碍，并探讨非妊娠WRA对MMS在预防和治疗贫血方面的看法和信念。这项定性研究纳入了一项针对WRA的孕前MMS干预试验，并分两个阶段进行。第一阶段评估了MMS依从性的障碍和促进因素。对发放MMS的社区卫生工作者（n = 7）以及参与试验的非妊娠WRA（n = 25）进行了个人访谈。第二阶段包括与参与试验的WRA（n = 26）进行的四个焦点小组讨论，进一步探讨了参与者对MMS供应和依从性的看法和信念，以及提高依从性的策略。报告的补充剂使用促进因素包括家庭支持、与社区卫生工作者的互动、MMS的便捷获取以及MMS带来的切实益处。孕前补充的障碍包括缺乏家庭支持、补充剂与产前护理的关联以及认为MMS没有益处。参与者报告了补充剂与药物的负面关联、围绕药物的个人和社会耻辱感以及补充剂服用时间表方面的挑战。对于成功的孕前MMS干预措施而言，需要让年轻女性及其家庭和社区相信补充剂的价值。利用孕前补充剂的公共卫生干预措施将需要对医疗保健提供者进行专门培训、提供有针对性的咨询材料以及社区家庭支持。
