F&N Bulletin Vol 23 No 1b - United Nations University

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64 33. Harper HA. Review of physiological chemistry. 22nd ed. Los Altos, Caliph, USA: Lange Medical Publication Maruzen Co., 1990. 34. Goodhart RS, Shills MF. Modern nutrition in health and disease. 6th ed. Philadelphia. Pa, USA: Lea and Febiger, 1980. 35. Edgerton VR, Gardner GW, Ohira Y, Gunwardena KA, Senewiratne B. Iron deficiency anaemia and its effect S. K. Mann et al. on working productivity and activity patterns. BMJ 1979:2:1546–9. 36. Gopaldas T, Seshadri S. Nutrition monitoring and assessment. Delhi. India: Oxford University Press, 1988. 37. Rowland TW, Deisroth MB, Green GM, Kelleher JF. The effect of iron therapy on the exercise capacity of non-anaemic iron deficient adolescent runners. Am J Dis Child 1988;142:165–9.
Toward better compliance with iron–folic acid supplements: Understanding the behavior of poor urban pregnant women through ethnographic decision models in Vadodara, India Jai Ghanekar, Shubhada Kanani, and Sucheta Patel Abstract This study made an attempt to develop ethnographic decision models to understand and improve iron–folic acid supplement procurement and compliance-related behaviors of poor urban pregnant women in Vadodara, India, based on data obtained through the use of qualitative research tools. Open-ended, in-depth interviews were conducted with 36 pregnant women (17–32 weeks of gestation) purposively selected from four urban slums. Fortnightly home visits were made to the houses of 20 pregnant women–family member pairs to elicit behaviors related to iron–folic acid supplement procurement and compliance at the household level, from which the ethnographic decision models were developed. The hemoglobin levels of these women were also assessed. Regular counseling until delivery, based on the ethnographic data, helped to improve compliance, which resulted in 95% of the women consuming over 90% of the required dose. The mean hemoglobin level also improved from 9.6 to 11.08 g/dl until the end of the last trimester. This study highlighted the need for qualitative ethnographic data to develop such models that would help in the understanding of specific behaviors that influence program acceptance. Such data would have policy-level implications, for example, developing appropriate information-educationcommunication material and counseling strategies. Introduction Nutritional anemia is a widely prevalent disorder in all segments of the population in the developing world, especially affecting pregnant women. In India, despite the existence of the National Nutritional Anemia Control Program since the 1970s, anemia continues to be widespread, with prevalence as high as 80% among The authors are affiliated with the Department of Foods and Nutrition in M. S. University of Baroda in Vadodara, India. pregnant women in some parts of the country [1]. The major constraints to effective management of iron supplementation programs, as identified by Gillespie et al. [2], include ineffective and irregular supply, procurement, and distribution of supplements; low accessibility and utilization of antenatal care services by pregnant women; inadequate counseling of mothers; undesirable side effects experienced by women; and low compliance of the pregnant women with the supplementation regimen. Evidence suggests that the outcome of iron-supplementation programs is affected by the behavior of the health-care providers and, more importantly, the pregnant women themselves. Qualitative anthropological research can help greatly in understanding issues related to procurement of and compliance with iron supplements, particularly specific behaviors among the pregnant women and their families. Further, drawbacks in the health system can be identified, including factors that hinder the effective distribution of supplements and counseling of women by the health-care providers. Qualitative research can also help identify factors for facilitating behavioral change through education and counseling, for example, how to motivate pregnant women to consume iron supplements regularly. In view of the above, it was considered worthwhile to explore and understand household-level factors that might be responsible for poor compliance with iron supplementation by pregnant women living in the urban slums of Vadodara. Therefore we attempted to develop ethnographic decision models (EDMs) to understand and improve procurement- and compliance-related behaviors of poor urban pregnant women with regard to iron supplements. EDMs are qualitative, causal pathways that predict what kinds of choices people make under specific circumstances. EDMs diagrammatically display the sequential pattern of people’s decision-making behaviors based on research data obtained through the use of qualitative, open-ended research tools [3]. Food and Nutrition Bulletin, vol. 23, no. 1 © 2002, The United Nations University. 65
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Contents Review articles Nuclear an
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Special Article Nuclear and isotopi
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Nuclear and isotopic techniques 5 T
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Nuclear and isotopic techniques 7 T
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Nuclear and isotopic techniques the
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Palm oil: A healthful and cost-effe
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Page 23 and 24: Introduction to three regional stud
Page 25 and 26: Nutritional status of urban primary
Page 31 and 32: Regional study of nutritional statu
Page 41 and 42: Regional study of nutritional statu
Page 49 and 50: Street food vendors their consumers
Page 51 and 52: Street food vendors whereas roasted
Page 53 and 54: Street food vendors Reardon [28] co
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Page 57 and 58: Iron and energy supplementation imp
Page 59 and 60: Iron and energy supplementation the
Page 61 and 62: Iron and energy supplementation The
Page 63: Iron and energy supplementation 63
Page 67 and 68: Toward better compliance with iron-
Page 73 and 74: Development and validation of a sho
Page 83 and 84: Factors associated with successful
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Page 91 and 92: Difference in goiter rates Methods
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Page 107 and 108: Discussion paper What care practice
Page 109 and 110: Letter to the Editor 109 iodized sa
Page 111 and 112: News and notes 2001 World Food Priz
Page 113 and 114: UNU Food and Nutrition Programme NU
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