Simple educational intervention will improve the efficacy of routine antenatal iron supplementation.

AIM: Sri Lanka has a policy of free provision of iron supplements to pregnant women. However, iron deficiency anemia remains common in pregnancy. METHODS: We tested the hypothesis that educating women regarding improving bioavailability could improve the efficacy of iron supplementation. The education focused on how best supplements could be taken and on how they should be stored. We carried out a study using a quasi-experimental design on a group of women attending for antenatal care at a suburban University Obstetric Unit in Sri Lanka. The control group had care free of charge including iron supplementation and antihelminthic therapy. In addition, the study group received an education in small groups regarding maximizing bioavailability of iron. Hemoglobin and iron status of the women were compared between the groups at recruitment and at 34 weeks of gestation. RESULTS: The two groups were equally matched in demographic data, and hemoglobin and iron status. There were significant differences between the two groups at 34 weeks in the hemoglobin levels, serum ferritin levels, anemia rates and the number with low ferritin (P < 0.0001 for all parameters), with a favorable outcome in the study group. The study group had used the iron tablets in ways that improved their bioavailability. CONCLUSION: A simple health education improved the efficacy of iron supplementation in this population. Such interventions should be an integral part of iron supplementation programs, especially in populations whose habits tend to reduce the bioavailability of iron.

Psychological reactions and coping strategies of Sri Lankan women carrying fetuses with lethal congenital malformations.

INTRODUCTION: Termination of pregnancy is a popular option for pregnancies complicated by lethal congenital malformations (LCMs). In Sri Lanka, where abortion laws are restrictive, this is not available. We studied the psychological responses and coping strategies of women who had to continue their pregnancies knowing the baby had a LCM. SETTING: A teaching hospital in Sri Lanka. STUDY DESIGN: Qualitative inquiry. METHOD: We conducted a semi-structured interview of 10 women whose fetuses were diagnosed to have a LCM. RESULTS: All women showed a grief reaction on hearing the news and were distressed about having to carry a futile pregnancy. Eight women were grateful they knew of the abnormality because it prepared them for the birth better, while the other two wished they had not known. They all found having to share facilities with 'normal' women to be painful. Seven women who received 'routine' antenatal care felt that the doctors were ill-equipped to deal with their situation. All felt that abortion should be legalised for LCMs. All engaged in religious rites believed to have miraculous powers, hoping that these will result in a normal baby. Two required specialised counselling. CONCLUSIONS: The diagnosis of a LCM causes severe distress and psychological reactions, which the staff dealing with these women should be aware of. Ideally, they should be provided care with minimum contact with other women, taking into account the futility of the pregnancy. Engagement in religious rites, even though with unreal expectations, may possibly help them in the long term bereavement process.

Counselling pregnant women with cancer.

Cancer during pregnancy represents a psychological and biological dilemma, as treatment should be directed to save two lives: the mother and the foetus. As a result of diagnosis and treatment, each patient will experience a range of practical, psychological and emotional challenges. Using a multidisciplinary approach, health professionals trained with communication skills can help reduce patient and family distress. It is essential that the obstetrician, oncologist and psychotherapist take leading roles. The patient and the family should be actively involved in the decision-making process. This will enhance confidence and support.

The urine protein heat coagulation test--a useful screening test for proteinuria in pregnancy in developing countries: a method validation study.

In many parts of the developing world, the urine protein heat coagulation test is routinely used to screen for proteinuria in pregnancy. The aim of this study was to determine whether > or =1+ on a standardised heat coagulation test reliably detects significant proteinuria and to compare it with the dipstick test for urinary protein. Heat coagulation test, dipstick test and 24-hour urine protein excretion results of 102 women were compared. > or =1+ on heat coagulation test is as sensitive and specific as > or =2+ on the dipstick test in detecting proteinuria of > or =500 mg/day. The heat coagulation test, however, is less sensitive than > or =1+ on dipstick in detecting lesser degrees of proteinuria.