ABSTRACT
Objectives: Reliable data on the micronutrient status of women and children was needed in Senegal to guide evidence-based decision making on interventions to reduce micronutrient deficiencies (MND). This study presents the findings of the first ever national MND survey carried out in Senegal in 2010. Methods: A cross sectional household survey sampled 1,810 households stratified by two urban and two rural zones. Data were collected on biochemical indicators of iron, vitamin A and zinc deficiency from 1,316 women 15-49 y and 1,887 children 12-59 mo. The analysis adjusted for subclinical inflammation. Results: Subclinical inflammation affected 27.7% of women and 49.5% of children. 44.7% women and 61.5% children had serum ferritin below 15 or 12 μg/l, respectively. 2.1% women and 18.2% children had serum retinol <0.70μmol/l; 66.7% women and 39.6% children had serum zinc below cutoff. Only 12.8% of women and 11.6% of children had no MND; 18.4% of women and 15.4% of children had at least 3 coexisting MND. The risk of a child having iron (OR 2.70; [1.49, 4.88]) or vitamin A (OR 13.66; [4.07, 45.84]) deficiency was higher in households where a woman had iron or vitamin A deficiency. Child anemia (66%) and zinc deficiency were not related to the status of women in the household. Women and children in rural areas were more affected by iron and vitamin A deficiencies compared to urban areas. Conclusions: MND affect a large proportion of women and children in Senegal. Further study of factors contributing to Intra-household clustering and rural/urban differences of MND is warranted.
ABSTRACT
Objectives: To identify existing barriers and potential enabling opportunities for the revitalization of iron and folic acid (IFA) supplementation to reduce anemia in pregnant women. Methods: A synthesis of formative research results from eight countries (Afghanistan, Bangladesh, Ethiopia, Indonesia, Kenya, Nepal, Nigeria, Senegal) was conducted to understand current antenatal care-seeking practices and identify relevant barriers and enablers associated with improved coverage and adherence to prenatal IFA supplementation. Results: Anemia in pregnancy is a well-known health concern by women, family decision-makers and health care providers in all countries studied. Widely varying views on when to start IFA supplementation, the dosage and the duration were expressed by women, family members and health care providers. Broad awareness of and modest attendance at facility-based ANC by pregnant women support this delivery channel for IFA, yet timely access is hindered by conflicting beliefs about the value of early initiation of ANC and the importance of prenatal IFA without anemia symptoms. Variable access and poor quality ANC services, specifically inadequate counseling on managing side effects and insufficient number of tablets given, are barriers to improving IFA coverage and ensuring adherence (≥90 tablets). In some cases, community-based delivery of ANC and IFA provided greater accessibility and follow-up for pregnant women. Conclusions: Improved ANC access and quality is needed to facilitate IFA supplementation. There is potential for community-based delivery and counseling to address concerns with IFA supplement supply and adherence. Renewed investment in IFA programs with strong behaviour change designs is urgently needed to achieve reductions in anemia.
ABSTRACT
Objectives: Treatment of diarrhea with zinc and ORS has both life-saving potential and diarrhea prevention benefits, yet here we explore the barriers as to why coverage and adherence remain low. Methods: A synthesis of formative research results from nine countries (Afghanistan, Bangladesh, Ethiopia, India, Indonesia, Kenya, Nepal, Nigeria, Senegal) was conducted to understand child diarrhea treatment practices and identify the barriers and enablers associated with ORS and zinc use. Results: In all countries, caregivers felt that diarrhea can be adequately cared for at home with local foods and drinks, traditional remedies and herbal medicine, tailored to the type of diarrhea. Perceived causes of diarrhea and advice from senior family members directly influenced treatment seeking. ORS was widely known for preventing dehydration in children with diarrhea, but was perceived as ineffective in stopping diarrhea. Caregivers and some health workers preferred antibiotics and anti-diarrheal medicines to “stop” diarrhea promptly. Outreach activities and free treatment for child diarrhea motivated caregivers to seek facility-based treatment. Barriers to ORS and zinc use include low awareness of zinc at multiple levels, frequent supply stock-outs and poor prescribing practices of health workers. Barriers to adherence to the full course of zinc include the common practice of stopping treatment when diarrhea stops and a lack of caregiver awareness of the benefits of zinc for prevention of diarrhea. Conclusions: Addressing context-specific beliefs about diarrhea causes and the effectiveness of home-remedies is essential to improve care-seeking behaviours. Maintaining adequate supplies and promoting the benefits of zinc will help to improve coverage and adherence.