Research Center for Public Health and Nutrition, National Research and Innovation Agency, West Java 16914, Indonesia.
Alma Ata Graduate School of Public Health, Universitas Alma Ata, Yogyakarta 55183, Indonesia.
Rural Remote Health. 2024 Nov;24(4):8722. doi: 10.22605/RRH8722. Epub 2024 Nov 8.
Adherence to iron-folic acid supplementation (IFAS) has been linked with maternal anaemia. While findings about determinants of IFAS adherence have been mixed across different research, there is inadequate evidence in relation to socioeconomic inequalities. This study aims to examine social determinants and socioeconomic inequalities of adherence to IFAS in urban and rural Indonesia.
We conducted a secondary analysis of the 2017 Indonesia Demographic and Health Survey by including a total of 12 455 women aged 15-49 years. The outcome was adherence to IFAS for at least 90 days. We used multiple logistic regression analysis adjusted for the survey design to analyse factors associated with IFAS adherence. We estimated socioeconomic inequalities using the Wagstaff normalized concentration index and plotted them using the concentration curve.
About half of women consumed IFAS for at least 90 days, with a higher proportion in urban areas (59.0%) than in rural areas (47.8%). Social determinants of adherence to IFAS were similar for urban and rural women. Overall, being an older woman, having weekly internet access, antenatal care for at least four visits, and residing in Java and Bali were significantly linked to IFAS adherence. Higher maternal education was significantly linked to IFAS adherence in urban settings, but not in rural settings. There were interactions between place of residence and woman's education (p<0.001) and household wealth (p<0.001). Concentration indices by woman's education and household wealth were 0.102 (p<0.001) and 0.133 (p<0.001), respectively, indicating pro-educated and pro-rich inequalities. However, no significant education-related disparity was found among rural women (p=0.126).
Women (age, education, occupation, birth number, internet access, involvement in decision-making), household (husband's education, household wealth), health care (antenatal care visit) and community (place of residence, geographic region) factors are associated with overall adherence to IFAS. These factors influence the adherence to IFAS in a complex web of deep-seated socioeconomic inequalities. Thus, programs and interventions to improve adherence to IFAS should target women of reproductive age and their families, particularly those from socioeconomically disadvantaged groups residing in rural areas.
铁叶酸补充剂（IFAS）的依从性与母体贫血有关。尽管不同研究中关于 IFAS 依从性决定因素的发现存在差异，但与社会经济不平等相关的证据不足。本研究旨在检验印度尼西亚城乡 IFAS 依从性的社会决定因素和社会经济不平等。
我们对 2017 年印度尼西亚人口与健康调查进行了二次分析，共纳入了 12455 名 15-49 岁的妇女。结果是至少 90 天的 IFAS 依从性。我们使用多因素逻辑回归分析调整了调查设计，分析了与 IFAS 依从性相关的因素。我们使用 Wagstaff 归一化集中指数估计了社会经济不平等，并使用集中曲线进行了绘制。
约有一半的妇女至少 90 天内服用 IFAS，城市地区（59.0%）的比例高于农村地区（47.8%）。城市和农村妇女对 IFAS 依从性的社会决定因素相似。总体而言，年龄较大、每周上网、产前检查至少 4 次、居住在爪哇和巴厘岛与 IFAS 依从性显著相关。母亲教育程度较高与城市地区 IFAS 依从性显著相关，但与农村地区无关。居住地和妇女教育（p<0.001）和家庭财富（p<0.001）之间存在交互作用。按妇女教育和家庭财富划分的集中指数分别为 0.102（p<0.001）和 0.133（p<0.001），表明存在有利于教育和有利于富裕的不平等。然而，农村妇女之间没有发现显著的教育相关差异（p=0.126）。
妇女（年龄、教育、职业、出生数、上网情况、参与决策）、家庭（丈夫教育、家庭财富）、医疗保健（产前检查次数）和社区（居住地、地理区域）因素与 IFAS 的整体依从性相关。这些因素以复杂的深层次社会经济不平等网络影响 IFAS 的依从性。因此，提高 IFAS 依从性的计划和干预措施应针对育龄妇女及其家庭，特别是居住在农村地区的社会经济弱势群体。
