ABSTRACT
Objectives: Ensuring adequate and timely availability of iron folic acid supplements at delivery points is a challenge for success of IFAS interventions. In Dakar and Fatick regions, the supply chain of IFAS was assessed to identify constraints and bottlenecks and to recommend solutions. Methods: Structured interviews with 84 health workers from 36 health facilities were carried out to determine the supply chain constraints in Dakar and Fatick regions. Transcriptions were analyzed using content analysis. Results: Health workers reported IFA stock-outs in 50% of included health districts. Although the needed quantities were reportedly available at regional drugs stores, the limited frequency of overall health commodity orders, applied by health districts to reduce costs, resulted in delayed IFA procurement when stocks were low. These delays were the primary cause of stock-outs reported by health workers. Conclusions: Adequate and consistent supply of IFA supplements could be ensured through allowing larger orders of IFA during regular commodity orders, reducing or subsidizing the cost of IFAS or shipment costs.
ABSTRACT
Objectives: Iron Folic acid supplementation (IFAS) during pregnancy has been implemented in Senegal for many years. However, prevalence of anemia is still high among pregnant women. To provide data for program improvement, we conducted a study to assess the prevalence of anemia and associated risk factors in Dakar and Fatick regions. Methods: The study was a cross-sectional, descriptive survey of 483 randomly selected pregnant women in Dakar and Fatick regions. Hemoglobin level was determined by HemoCue photometer, and questionnaires were used to collect data on socio-economic characteristics, knowledge, attitudes, and practices. Data were cleaned, coded and analyzed with Epi Info. Financial barriers were defined as: family decision makers who restrict expenditures, limited financial resources. Results: Results showed that the prevalence of anemia (Hb <11g/dL) among pregnant women was 66.4% and 71.4% in Dakar and Fatick regions, respectively. Pregnant women had lower risks of being anemic when they had an income-generating activity (OR=1.63, CI (1.1 - 2.5)), had been supplemented for at least 90 days (OR=2.26, CI (1.2 - 4.3)), and had no financial barrier to access IFAS (OR=0.40, CI (0.1 - 0.9]. 50% of the pregnant women wrongly associated side effects to IFA consumption and consequently initiated IFAS after the 2nd trimester. Conclusions: Anemia is a severe public health problem among pregnant women in these two regions. Interventions designed to address anemia should improve accessibility to IFAS through promotion of early initiation of IFAS during pregnancy and distribution of free IFAS.
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.