Galloway R, McGuire J
Population, Health and Nutrition Department, World Bank, Washington, DC 20433.
Soc Sci Med. 1994 Aug;39(3):381-90. doi: 10.1016/0277-9536(94)90135-x.
Iron deficiency anemia affects over 2 billion people. Particularly at risk are pregnant women and young children. Although distribution of iron supplements is practised in many antenatal care programs in developing countries, it has often been alleged that pregnant women do not take them. Poor compliance arises not only because of patient behavior but also from factors out of the patient's control. This paper presents the results of a review of the literature on medical compliance to determine whether iron supplementation is different from other medications, to assess the known levels of compliance, and to synthesize recommendations for improving compliance relevant to iron supplementation. The review showed that compliance with iron therapy is a specific case of medical compliance. Reasons for non-compliance with iron deficiency treatment include: inadequate program support (lack of political commitment and financial support); insufficient service delivery (poor provider-user dynamics; lack of supplies, access, training, and motivation of health care professionals); and patient factors (misunderstanding instructions, side effects, frustration about the frequency and number of pills taken, migration, fear of having big babies, personal problems, nausea that accompanies pregnancy, and the subtlety of anemia which makes demand for treatment low). Much has been made about the side effects (nausea, constipation, etc.) that women might experience during iron therapy as the cause of poor compliance with iron supplementation without justification according to this review. Instead, unavailability of iron supplements was the most common reason why women did not take iron supplements. Women bear a disproportionate burden from iron deficiency anemia even though the technology exists to address the problem at low cost. Governments and health care professionals must renew their commitment to iron therapy by monitoring and improving compliance. We can significantly improve compliance by: making sure that iron supplements are available at all times; providing advanced warning about the possibility of side effects; involving the patient in the therapeutic strategy; and providing reminders, such as posters and calendars, about taking supplements.
缺铁性贫血影响着超过20亿人。孕妇和幼儿尤其面临风险。尽管许多发展中国家的产前护理项目都在发放铁补充剂，但人们常常声称孕妇不服用这些补充剂。依从性差不仅是因为患者的行为，还源于患者无法控制的因素。本文介绍了一项关于医疗依从性的文献综述结果，以确定铁补充剂与其他药物是否不同，评估已知的依从性水平，并综合提出与铁补充剂相关的提高依从性的建议。该综述表明，铁疗法的依从性是医疗依从性的一个具体案例。缺铁性贫血治疗不依从的原因包括：项目支持不足（缺乏政治承诺和资金支持）；服务提供不足（医患关系不佳；医疗用品短缺、获取困难、医护人员缺乏培训和积极性）；以及患者因素（误解医嘱、副作用、对服药频率和数量感到沮丧、迁移、害怕生出巨大儿、个人问题、孕期恶心以及贫血症状不明显导致治疗需求低）。根据这项综述，人们常常无端将女性在铁疗法期间可能经历的副作用（恶心、便秘等）视为铁补充剂依从性差的原因。相反，铁补充剂无法获取是女性不服用铁补充剂的最常见原因。尽管存在低成本解决该问题的技术，但缺铁性贫血给女性带来了不成比例的负担。政府和医护人员必须通过监测和提高依从性来重新致力于铁疗法。我们可以通过以下方式显著提高依从性：确保随时都有铁补充剂；提前告知可能出现的副作用；让患者参与治疗策略；以及提供提醒，如海报和日历，以提醒服用补充剂。
