Labonté Jocelyne M, Hoang Mai-Anh, Panicker Aishwarya, Kroeun Hou, Sokchea Meng, Sambo Sreang, Sokhal Vin, Sauer Cassandra, Chea Mary, Karakochuk Crystal D
Interdisciplinary School of Health Sciences, University of Ottawa, Canada.
Helen Keller Intl, Asia Pacific, Manila, Philippines.
Matern Child Nutr. 2025 Jan;21(1):e13745. doi: 10.1111/mcn.13745. Epub 2024 Oct 21.
For decades, iron-folic acid (IFA) supplements have been provided to pregnant women in Cambodia through antenatal care (ANC) services. However, mounting evidence suggests that multiple micronutrient supplements (MMS) are superior to IFA supplements in achieving positive pregnancy outcomes. The possibility of transitioning from IFA supplements to MMS in government-run health centres is currently being assessed in Cambodia. A crucial component of this assessment involves identifying factors that can influence adherence to MMS, as low adherence can reduce supplement effectiveness. Consequently, this study aimed to explore the potential barriers and enablers to MMS adherence and identify the strengths and challenges of current ANC services. Data were collected through nine focus group discussions with pregnant women (n = 19), family members (n = 18) and midwives (n = 18) and three in-depth interviews with maternal and child health chiefs (n = 3) in Cambodia and analysed via content analysis. Factors found to influence MMS adherence included attitudes, perceptions and beliefs about MMS; knowledge related to supplementation; ANC counselling; family influence; physical health; access to ANC; supply of MMS; and supplementation norms. Noted strengths of ANC services were the quality of ANC materials, tailored patient education, midwife-patient relationships and flexibility of provided services. Primary challenges related to poor availability of ANC materials, inadequate midwife training, heavy workload, limited funding and suboptimal physical spaces for delivering ANC services. To effectively promote MMS adherence, strategies must involve pregnant women, family members and community leaders; seek to address knowledge gaps and misconceptions related to MMS; and enhance the availability and accessibility of ANC services.
几十年来，柬埔寨一直通过产前保健（ANC）服务为孕妇提供铁叶酸（IFA）补充剂。然而，越来越多的证据表明，在实现良好的妊娠结局方面，多种微量营养素补充剂（MMS）优于IFA补充剂。目前柬埔寨正在评估在政府运营的健康中心从IFA补充剂过渡到MMS的可能性。这项评估的一个关键组成部分是确定可能影响MMS依从性的因素，因为依从性低会降低补充剂的效果。因此，本研究旨在探讨MMS依从性的潜在障碍和促进因素，并确定当前ANC服务的优势和挑战。通过与柬埔寨的孕妇（n = 19）、家庭成员（n = 18）和助产士（n = 18）进行九次焦点小组讨论，以及与母婴健康负责人（n = 3）进行三次深入访谈收集数据，并通过内容分析进行分析。发现影响MMS依从性的因素包括对MMS的态度、认知和信念；与补充相关的知识；ANC咨询；家庭影响；身体健康；获得ANC服务的机会；MMS的供应；以及补充规范。ANC服务的显著优势包括ANC材料的质量、量身定制的患者教育、助产士与患者的关系以及所提供服务的灵活性。主要挑战与ANC材料供应不足、助产士培训不足、工作量大、资金有限以及提供ANC服务的物理空间不理想有关。为了有效促进MMS依从性，策略必须涉及孕妇及其家庭成员和社区领袖；设法解决与MMS相关的知识差距和误解；并提高ANC服务的可及性和可用性。
