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      Factors associated with compliance to recommended micronutrients uptake for prevention of anemia during pregnancy in urban, peri-urban, and rural communities in Southeast Nigeria

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          Abstract

          Background

          The study investigated the factors associated with compliance to the recommended ≥90-day uptake of micronutrients for prevention of iron-deficiency anemia during pregnancy in Nigeria.

          Methods

          A cross-sectional study of 1500 women who had babies within 6 months prior to the survey, drawn from six urban, peri-urban, and rural local government areas in Enugu and Imo States of Nigeria, was conducted, using a structured questionnaire. A focus group discussion was held with grandmothers and fathers of the new baby. In-depth interviews were held with health workers.

          Results

          There were six demographic factors in the bivariate analysis: living in an urban center and close to health facility, and being wealthy, with post-secondary education as well as older and engaged in civil service showed significant association with compliance. The urban residents complied more than the peri-urban and rural residents ( χ 2 = 12.749; p = 0.002). Those living close to the health facilities complied more than those living far away ( χ 2 = 24.638; p < 0.001). Those in higher wealth quintile complied more ( χ 2 = 13.216; p < 0.010). Utilization of antenatal clinics during pregnancy showed statistically significant association with compliance. Those who used the ANC services complied more than those that did not ( χ 2 = 6.324; p = 0.010) and the more frequent the use of ANC services the more the compliance ( χ 2 = 14.771; p < 0.001). These results were confirmed when the opinions expressed in the urban, peri-urban, and rural communities are compared. However, the multivariate binary logistic regression highlighted only urban residence, closeness to health facilities, and utilization of ANC services as positively associated with compliance.

          Conclusion

          These findings could help in targeting health education program to increase compliance to the recommended uptake of micronutrients in prevention of anemia during pregnancy.

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          Micronutrients in Pregnancy in Low- and Middle-Income Countries

          Ian Darnton-Hill, Uzonna Mkparu (2015)
          Pregnancy is one of the more important periods in life when increased micronutrients, and macronutrients are most needed by the body; both for the health and well-being of the mother and for the growing foetus and newborn child. This brief review aims to identify the micronutrients (vitamins and minerals) likely to be deficient in women of reproductive age in Low- and Middle-Income Countries (LMIC), especially during pregnancy, and the impact of such deficiencies. A global prevalence of some two billion people at risk of micronutrient deficiencies, and multiple micronutrient deficiencies of many pregnant women in LMIC underline the urgency to establishing the optimal recommendations, including for delivery. It has long been recognized that adequate iron is important for best reproductive outcomes, including gestational cognitive development. Similarly, iodine and calcium have been recognized for their roles in development of the foetus/neonate. Less clear effects of deficiencies of zinc, copper, magnesium and selenium have been reported. Folate sufficiency periconceptionally is recognized both by the practice of providing folic acid in antenatal iron/folic acid supplementation and by increasing numbers of countries fortifying flours with folic acid. Other vitamins likely to be important include vitamins B12, D and A with the water-soluble vitamins generally less likely to be a problem. Epigenetic influences and the likely influence of micronutrient deficiencies on foetal origins of adult chronic diseases are currently being clarified. Micronutrients may have other more subtle, unrecognized effects. The necessity for improved diets and health and sanitation are consistently recommended, although these are not always available to many of the world’s pregnant women. Consequently, supplementation programmes, fortification of staples and condiments, and nutrition and health support need to be scaled-up, supported by social and cultural measures. Because of the life-long influences on reproductive outcomes, including inter-generational ones, both clinical and public health measures need to ensure adequate micronutrient intakes during pregnancy, but also during adolescence, the first few years of life, and during lactation. Many antenatal programmes are not currently achieving this. We aim to address the need for micronutrients during pregnancy, the importance of micronutrient deficiencies during gestation and before, and propose the scaling-up of clinical and public health approaches that achieve healthier pregnancies and improved pregnancy outcomes.
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            Diagnosis and management of iron deficiency anemia in the 21st century

            T. D. Johnson-Wimbley, D Graham (2011)
            Iron deficiency is the single most prevalent nutritional deficiency worldwide. It accounts for anemia in 5% of American women and 2% of American men. The goal of this review article is to assist practitioners in understanding the physiology of iron metabolism and to aid in accurately diagnosing iron deficiency anemia. The current first line of therapy for patients with iron deficiency anemia is oral iron supplementation. Oral supplementation is cheap, safe, and effective at correcting iron deficiency anemia; however, it is not tolerated by some patients and in a subset of patients it is insufficient. Patients in whom the gastrointestinal blood loss exceeds the intestinal ability to absorb iron (e.g. intestinal angiodysplasia) may develop iron deficiency anemia refractory to oral iron supplementation. This population of patients proves to be the most challenging to manage. Historically, these patients have required numerous and frequent blood transfusions and suffer end-organ damage resultant from their refractory anemia. Intravenous iron supplementation fell out of favor secondary to the presence of infrequent but serious side effects. Newer and safer intravenous iron preparations are now available and are likely currently underutilized. This article discusses the possible use of intravenous iron supplementation in the management of patients with severe iron deficiency anemia and those who have failed oral iron supplementation.
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              Park’s Textbook of Preventive and Social Medicine

              K. PARK, K Park, Changhun Park … (2011)
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                Author and article information

                Contributors
                Nkechi G. Onyeneho: nkechi.onyeneho@unn.edu.ng , nkechux@yahoo.com
                Journal
                Journal ID (nlm-ta): J Health Popul Nutr
                Journal ID (iso-abbrev): J Health Popul Nutr
                Title: Journal of Health, Population, and Nutrition
                Publisher: BioMed Central (London )
                ISSN (Print): 1606-0997
                ISSN (Electronic): 2072-1315
                Publication date (Electronic): 2 November 2016
                Publication date PMC-release: 2 November 2016
                Publication date Collection: 2016
                Volume: 35
                Electronic Location Identifier: 35
                Affiliations
                [1 ]Department of Global Health and Population, Takemi Program in International Health, Harvard TH Chan School of Public Health, 677 Huntington Avenue, Boston, MA USA
                [2 ]Department of Sociology/Anthropology, University of Nigeria, Nsukka, Enugu State Nigeria
                [3 ]Department of Social Work, University of Nigeria, Nsukka, Enugu State Nigeria
                [4 ]Harvard School of Public Health, 677 Huntington Avenue, Boston, MA USA
                [5 ]Department of Social and Behavioral Sciences, Harvard School of Public Health, 677 Huntington Avenue, Boston, MA USA
                Article
                Publisher ID: 68
                DOI: 10.1186/s41043-016-0068-7
                PMC ID: 5090877
                PubMed ID: 27806723
                SO-VID: a89c79bd-8091-4eee-a01f-e0919353f573
                Copyright © © The Author(s). 2016
                License:

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                Date received : 11 June 2016
                Date accepted : 15 September 2016
                Funding
                Funded by: Japanese Medical Association
                Categories
                Subject: Research Article
                Custom metadata
                issue-copyright-statement © The Author(s) 2016

                ScienceOpen disciplines: Nutrition & Dietetics
                Keywords: anemia,pregnancy,compliance,micronutrients
                Data availability:
                ScienceOpen disciplines: Nutrition & Dietetics
                Keywords: anemia, pregnancy, compliance, micronutrients

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