Predictors of adherence to micronutrient supplementation before and during pregnancy in Vietnam
Predictors of adherence to micronutrient supplementation before and during pregnancy in Vietnam
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DOI：
10.1186/s12889-017-4379-4
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发表时间：
2017-05-16
影响因子：
4.5
通讯作者：
Ramakrishnan, Usha
中科院分区：
文献类型：
--
作者：
Gonzalez-Casanova, Ines;Phuong Hong Nguyen;Ramakrishnan, Usha
背景：缺乏对微量营养素补充的坚持常常限制了公共卫生计划的有效性。虽然怀孕期间坚持补充微量营养素的预测因素有很好的记录，但坚持孕前补充的信息很少。本研究的目的是描述在越南参加一项随机对照试验的妇女中坚持孕前和产前微量营养素补充的预测因素。方法：从越南农村的一项双盲随机对照试验中前瞻性地收集依从性数据。511名育龄妇女随机接受孕前补充剂，每周食用叶酸，铁和叶酸（IFA）或多种微量营养素。怀孕的妇女在分娩前每天服用IFA补充剂。村卫生工作者每两周到参与者家中进行一次访问，提供补充剂，并记录其摄入量和副作用。多变量逻辑回归用于评估个人、家庭和方案的补充剂依从性预测因子。结果：依从性很高，分别有78%和82%的妇女服用了超过80%的孕前和产前补充剂。少数民族妇女（OR = 0.78 95% CI = 0.67, 0.91）和农民（OR = 0.71 95% CI = 0.58, 0.88）不太可能摄入> - 80%的孕前补充剂，而社会经济地位（SES） （OR = 2.71最高五分位数vs最低五分位数；95% CI = 2.10, 3.52）与整个孕前样本中> - 80%的依从性呈正相关（n = 4417）。第一次怀孕的妇女与多次分娩的妇女相比，产前依从性较低。在方案层面，每次村卫生工作者访问与妊娠前3-5%和妊娠期间18%的高依从率相关。结论：决定依从性的关键因素包括社会经济地位、种族、职业（农民）和平等，这可能有助于针对妇女进行补充剂依从性咨询。在怀孕前和怀孕期间，增加与乡村保健工作者的接触与坚持补充微量营养素呈正相关，这表明需要资源来支持社区向育龄妇女的推广。
Background: Poor adherence to micronutrient supplementation often limits the effectiveness of public health programs. While predictors of adherence to micronutrient supplementation during pregnancy are well documented, information on adherence to preconception supplements is scarce. The objective of this study was to describe the predictors of adherence to preconception and prenatal micronutrient supplementation among women participating in a randomized control trial in Vietnam.Methods: Adherence data were collected prospectively from a double blind randomized controlled trial in rural Vietnam. Five thousand eleven women of reproductive age were randomized to receive preconception supplements for weekly consumption containing either: Folic Acid, Iron and Folic Acid (IFA), or Multiple Micronutrients. Women who became pregnant received prenatal IFA supplements for daily consumption through delivery. Village health workers visited participants' homes every two weeks to deliver supplements and record consumption and side effects. Multivariate logistic regression was used to assess individual, household, and programmatic predictors of supplement adherence.Results: Adherence was high with 78 and 82% of the women consuming more than 80% of the preconception and prenatal supplements, respectively. Women of minority ethnicity (OR = 0.78 95% CI = 0.67, 0.91) and farmers (OR = 0.71 95% CI = 0.58, 0.88) were less likely to consume > 80% of the preconception supplements while socioeconomic status (SES) (OR = 2.71 highest vs. lowest quintile; 95% CI = 2.10, 3.52) was positively associated with > 80% adherence in the entire preconception sample with available information (n = 4417). Women in their first pregnancy had lower prenatal adherence compared to multiparous women. At the programmatic level, each village health worker visit was associated with higher odds of > 80% adherence by 3-5% before pregnancy and 18% during pregnancy.Conclusions: Key determinants of adherence included SES, ethnicity, occupation (farmer) and parity which may be helpful for targeting women for counseling on supplement adherence. Increased contact with village health workers was positively associated with adherence to micronutrient supplementation both before conception and during pregnancy indicating the need for resources to support community outreach to women of reproductive age.