Kebaabetswe Poloko, Diseko Modiegi, Zash Rebecca, Mayondi Gloria, Mabuta Judith, Mmalane Mompati, Makhema Joseph, Lockman Shahin, Moeng Letumile, Lowenthal Elizabeth, Shapiro Roger, Caniglia Ellen C
Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana.
Beth Israel Deaconess Medical Center, Boston, USA.
BMC Public Health. 2024 Dec 4;24(1):3369. doi: 10.1186/s12889-024-20685-5.
Antenatal iron and folic acid (IFA) supplementation remains an effective strategy in the prevention of maternal anemia and low birthweight and is universally recommended by WHO. However, uptake of IFA has varied globally due to challenges with acceptability, supply and distribution, counselling and knowledge, and access to health services. In Botswana, nearly one-third of pregnant women engaged in antenatal care do not receive IFA, despite it being standard of care. The objectives of this study were to assess knowledge of and barriers and facilitators to IFA supplementation before and during pregnancy.
We conducted qualitative interviews with two key stakeholder groups at two different levels-the individual level (pregnant women) and the service delivery level (health care providers). Here, we present results from interviews with pregnant women at two representative antenatal clinic sites in Botswana in 2022.
Pregnant women were motivated to be healthy and were knowledgeable about the benefits of supplementation during pregnancy to mothers and their infants; however, women knew more about the benefits of iron than folic acid. Most women were in favor of receiving IFA supplementation prior to pregnancy and receiving fortified foods. Several key barriers were identified: lack of supplement availability in the clinics, poverty, side effects, number of tablets, and adherence. Approaches to overcome these barriers included improving supplement availability, improving health education, increasing supply of nutritious and fortified foods, backyard gardens, and increasing family and monetary support.
Our study identified a need to 1) increase the availability of supplementation at antenatal clinics and 2) improve education regarding supplementation to include information about the benefits of folic acid and other micronutrients. Implementation research is needed to ascertain whether increasing supply and improving education could increase utilization of supplementation during pregnancy, with the ultimate goal of improving maternal and infant outcomes.
产前补充铁和叶酸（IFA）仍然是预防孕产妇贫血和低出生体重的有效策略，并且得到了世界卫生组织的普遍推荐。然而，由于在可接受性、供应与分配、咨询与知识以及获得卫生服务方面存在挑战，全球范围内IFA的服用情况各不相同。在博茨瓦纳，尽管产前保健是标准护理，但近三分之一接受产前保健的孕妇未接受IFA。本研究的目的是评估怀孕前和怀孕期间对IFA补充剂的了解情况以及障碍和促进因素。
我们在两个不同层面——个体层面（孕妇）和服务提供层面（医疗保健提供者）——对两个关键利益相关者群体进行了定性访谈。在此，我们展示了2022年在博茨瓦纳两个具有代表性的产前诊所对孕妇进行访谈的结果。
孕妇有保持健康的积极性，并且了解孕期补充对母亲及其婴儿的益处；然而，女性对铁的益处的了解多于叶酸。大多数女性赞成在怀孕前接受IFA补充剂并食用强化食品。确定了几个关键障碍：诊所缺乏补充剂、贫困、副作用、药片数量以及依从性。克服这些障碍的方法包括提高补充剂的可获得性、改善健康教育、增加营养和强化食品的供应、后院菜园，以及增加家庭和金钱支持。
我们的研究确定有必要1）增加产前诊所补充剂的可获得性，以及2）改善关于补充剂的教育，包括叶酸和其他微量营养素益处的信息。需要进行实施研究，以确定增加供应和改善教育是否能提高孕期补充剂的利用率，最终目标是改善母婴结局。
