Effect of Integrated Pictorial Handbook Education and Counseling on Improving Anemia Status, Knowledge, Food Intake, and Iron Tablet Compliance Among Anemic Pregnant Women in Indonesia: A Quasi-Experimental Study.

PURPOSE: To determine the effect of individual education through a pictorial handbook on anemia in conjunction with counseling on improving hemoglobin and hematocrit level, birth weight, knowledge, iron-rich food and iron-folic acid (IFA) intake. PATIENTS AND METHODS: The study developed a pictorial handbook that was conceptualized based on the Health Belief Model and adjusted to some cultural and local contexts. A quasi-experimental pre-test-post-test control group design was used, purposefully conducted between two homogenous municipalities, each having a rate of anemic pregnancy that was 40% or greater. The sample consists of 140 anemic pregnant women randomly allocated via lottery into two groups; the intervention group (n=70), which received two home visits-one for education and another for a counseling session, and control group (n=70), which received routine antenatal care. A chi-square test and a Mann-Whitney U-test were conducted to compare the baseline socio-demographics. An analysis of covariance (ANCOVA), controlling some possible confounders, was performed to analyze the effect of intervention. RESULTS: The post-test means of hemoglobin F (1, 132) = 122, p-value <0.001, and hematocrit levels F (1, 132) = 373, p-value <0.001, were significantly different and higher in the intervention group compared to the control group. Similar results were found in knowledge, food frequency score, number of IFA intake (with p-value <0.001), birth weight and daily iron intake from food (with p-value <0.05). The intervention had a particularly large effect on food frequency score and number of IFA intake, and medium effect on hemoglobin and hematocrit levels. CONCLUSION: Individual education through a pictorial handbook on anemia in conjunction with the counseling intervention program had a positive impact on hemoglobin and hematocrit levels for anemic pregnant women in their third trimester of pregnancy.

Micronutrient Intake And Perceived Barriers Among Anaemic Pregnant Women In Aceh, Indonesia.

BACKGROUND: Estimating vitamin, mineral intakes related to anaemia and describing perception regard pregnancy diet, accessibility to foodstuff among first ANC visitor of anaemic pregnant women aged above 20 years in Province Aceh, Indonesia. METHODS: A cross sectional mixmethod of quantitatively and focus group discussion (FGD) was conducted at two municipalities having more than 40% anaemic pregnancy. One hundred fifty-eight anaemic pregnant women were interviewed regarding socio-demographic and three days of 24-hours food recall, in addition to FGD at each municipality using FGD guidelines about nutritional anaemia. Food recall data was analysed using software NutriSurvey Indonesia, deficiency is defined as daily intake below 77% recommended dietary allowances (RDA) Indonesia. The FGD result was analysed by content analysis and clarified with representative quotes. RESULTS: Prevalence of deficiencies intake were folate (98.7%), vitamin B6 (91.1%), vitamin B2 (90.5%), iron (89.2%), zinc (87.3%), vitamin E (84.8%), vitamin C (79.7%), vitamin A (74.1%), copper (67.1%) and vitamin B12 (30.4%). Anaemic pregnant women noticed to consume more amount of food during pregnancy, and preferred to access foodstuff at shop nearby the house. CONCLUSIONS: Other than low iron intake, more than 90% anaemic pregnant women were also deficiency in folate, vitamin B6 and vitamin B2. Perceived of less acknowledgement about affordable cost micronutrient-rich food, high cost of quality-food, sufficient to varieties foodstuff at neighbourhood shop prevents them from making correct food choices subsequently barrier to the food access and intake.

An integrated program with home blood-pressure monitoring and village health volunteers for treating poorly controlled hypertension at the primary care level in an urban community of Thailand.

PURPOSE: Hypertension (HT) is accountable for death in half of the patients suffering from heart disease and stroke. Many treatment strategies have been used, but little research exists on an integrated program with home blood pressure monitoring (HBPM) and village health volunteers (VHVs) in an urban area of Thailand. The present study aims to determine the effectiveness of the integrated program, HBPM, and VHVs in supporting the target population. PATIENTS AND METHODS: This quasi-experiment was conducted from July to November 2017. Patients with poorly controlled HT were randomly selected from each of the two primary care units in Nakhon Ratchasima, Thailand. The participants were separated into an experiment (n=63) and control group (n=65). The experiment group participated in the integrated program, which was based on the 20-item Health Literate Care Model. A valid and reliable questionnaire was used to collect data from participant interviews. Blood-pressure monitoring was used to measure systolic home blood pressure and diastolic home blood pressure. Descriptive statistics, chi-squared tests, Fisher's exact test, the independent t-test, and the Wilcoxon-Mann-Whitney test were used to compare the baseline data. Multiple logistic regression was used to compare the differences between the mean changes in the outcomes. RESULTS: At the end of the 3-month follow-up appointment, significant statistical changes were found. Systolic home blood pressure, diastolic home blood pressure, and body mass index changed -4.61 (95% CI -8.32, -0.90) mmHg (P-value=0.015), -3.5 (95% CI -5.31, -1.72) mmHg (P-value <0.001), and -0.86 (95% CI -1.29, -042) (P-value <0.001) respectively. Participant scores in lifestyle and management knowledge, and self-management behaviors significantly increased by 0.76 (95% CI 0.15-1.38) point (P-value=0.016) and 0.15 (95% CI 0.06, 0.24) point (P-value=0.001), respectively. CONCLUSION: The integrated program, HBPM, and VHVs were effective in decreasing blood pressure and body mass index, and increasing knowledge and self-management behaviors among urban patients with poorly controlled HT.

Appearance and potential predictors of poorly controlled hypertension at the primary care level in an urban community.

PURPOSE: Hypertension (HT) is the major risk factor for cardiovascular diseases because of its poor control. To control HT at the primary care level in urban communities, there is a demand for deeper comprehension of the manifestations of poorly controlled HT. This study aimed to examine appearance of HT, including the association between the appearance and home blood pressure (HBP) control at the primary care level in urban communities. PATIENTS AND METHODS: A cross-sectional study was conducted in July-October 2017 in an urban community in Thailand. The total sample size from randomization was 125 poorly controlled HT patients who were diagnosed with an average clinic blood pressure ≥140/90 mmHg in their last three visits. Data were collected by face-to-face interviews, HBP monitoring (HBPM), and blood and urine testing. Data analysis was conducted via descriptive statistics and the chi-square tests, with a significance level of p<0.05. RESULTS: HBPM revealed that 58.4% of patients with poorly controlled blood pressure from clinic measurement had a systolic blood pressure and diastolic blood pressure that were below the HBP target. Most patients were overweight/obese, but they were nonsmokers and nondrinkers. As comorbidities, they had hyperlipidemia (64.0%) and diabetes mellitus (53.0%). One-quarter of them had good levels of knowledge and literacy. Nearly half had good health self-care literacy. Only 13% exhibited adequate self-management behaviors, but more than half had biochemistry results within normal limits. There were significant associations of smoking history and having hyperlipidemia as a comorbidity with HBP control (p =0.010 and 0.046, respectively). CONCLUSION: The role of HBPM is important in practice when it comes to monitoring HT control at the primary care level in an urban context. Smoking cessation and control of the blood lipid levels should be highlighted not only at the practice, but also at the policy level.

The positive effects of a peer-led intervention system for individuals with a risk of metabolic syndrome.

BACKGROUND: Metabolic syndrome (MetS) is a major health risk in Thailand. Although it is reported that females have a higher rate of MetS than males, very few peer-led intervention studies have been conducted on specific groups, such as seamstresses, at risk of MetS. This study aimed to evaluate the effect of a peer-led intervention program on reducing MetS risk factors in individuals working in Thai Uniform Sewing Military Factories. METHODS: A quasiexperimental program was introduced using a pre- and posttest design that was applied to female sewing factory workers selected for this research. All participants had at least one of the key MetS symptoms. The experimental group (N=50 participants) received 12 weekly peer-led individual support discussion sessions that included both dietary and physical activity (PA) advice and the control group (N=50 participants) followed their usual daily routines. The Student's t-test and the Pearson's chi-squared test were used to compare the differences of baseline data and analysis of variance was used for analysis of the data after intervention. RESULTS: The results showed that after 3 months of participation, when compared to the control group, the experimental group had significantly improved systolic blood pressure (BP) (P=0.04), diastolic BP (P<0.001), PA (P=0.05), knowledge scores of MetS, perception of MetS and risk factors (P<0.001), and stress assessment (P=0.002). Waist circumference, body mass index, and Food Frequency Questionnaire score were not significantly different but still improved. CONCLUSION: Findings from this study suggest that a peer-led support program can be introduced as an effective means of improving the behaviors of mostly sedentary factory workers at risk of MetS caused by working habits that are detrimental to health.