Social determinants and socioeconomic inequalities in adherence to antenatal iron-folic acid supplementation in urban and rural Indonesia.

IF 2 4区 医学 Q3 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH
Rural and remote health Pub Date : 2024-11-01 Epub Date: 2024-11-08 DOI:10.22605/RRH8722
Bunga A Paramashanti, Esti Nugraheny, Suparmi Suparmi, Tin Afifah, Wahyu Pudji Nugraheni, Yuni Purwatiningsih, Oktarina Oktarina, Muhammad Agus Mikrajab, Effatul Afifah, Yhona Paratmanitya
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引用次数: 0

Abstract

Introduction: Adherence to iron-folic acid supplementation (IFAS) has been linked with maternal anaemia. While findings about determinants of IFAS adherence have been mixed across different research, there is inadequate evidence in relation to socioeconomic inequalities. This study aims to examine social determinants and socioeconomic inequalities of adherence to IFAS in urban and rural Indonesia.

Methods: We conducted a secondary analysis of the 2017 Indonesia Demographic and Health Survey by including a total of 12 455 women aged 15-49 years. The outcome was adherence to IFAS for at least 90 days. We used multiple logistic regression analysis adjusted for the survey design to analyse factors associated with IFAS adherence. We estimated socioeconomic inequalities using the Wagstaff normalized concentration index and plotted them using the concentration curve.

Results: About half of women consumed IFAS for at least 90 days, with a higher proportion in urban areas (59.0%) than in rural areas (47.8%). Social determinants of adherence to IFAS were similar for urban and rural women. Overall, being an older woman, having weekly internet access, antenatal care for at least four visits, and residing in Java and Bali were significantly linked to IFAS adherence. Higher maternal education was significantly linked to IFAS adherence in urban settings, but not in rural settings. There were interactions between place of residence and woman's education (p<0.001) and household wealth (p<0.001). Concentration indices by woman's education and household wealth were 0.102 (p<0.001) and 0.133 (p<0.001), respectively, indicating pro-educated and pro-rich inequalities. However, no significant education-related disparity was found among rural women (p=0.126).

Conclusion: Women (age, education, occupation, birth number, internet access, involvement in decision-making), household (husband's education, household wealth), health care (antenatal care visit) and community (place of residence, geographic region) factors are associated with overall adherence to IFAS. These factors influence the adherence to IFAS in a complex web of deep-seated socioeconomic inequalities. Thus, programs and interventions to improve adherence to IFAS should target women of reproductive age and their families, particularly those from socioeconomically disadvantaged groups residing in rural areas.

印度尼西亚城市和农村地区坚持产前补充铁质叶酸的社会决定因素和社会经济不平等。
导言:坚持服用铁-叶酸补充剂(IFAS)与孕产妇贫血有关。虽然不同研究对坚持服用叶酸补充剂的决定因素的调查结果不一,但与社会经济不平等有关的证据不足。本研究旨在探讨印度尼西亚城市和农村地区遵守《国际母乳喂养标准》的社会决定因素和社会经济不平等现象:我们对 2017 年印度尼西亚人口与健康调查进行了二次分析,共纳入了 12 455 名 15-49 岁的女性。结果是至少 90 天坚持使用 IFAS。我们使用根据调查设计进行调整的多元逻辑回归分析来分析与坚持 IFAS 相关的因素。我们使用瓦格斯塔夫归一化浓度指数估算了社会经济不平等,并使用浓度曲线对其进行了绘制:结果:大约一半的妇女至少在 90 天内服用了 IFAS,城市地区的比例(59.0%)高于农村地区(47.8%)。城市和农村妇女坚持服用 IFAS 的社会决定因素相似。总体而言,高龄产妇、每周能上网、至少接受过四次产前检查以及居住在爪哇岛和巴厘岛与坚持实施《综合产前保健计划》有显著关系。在城市地区,孕产妇学历越高,越容易坚持使用《国际家庭护理标准》,而在农村地区则不然。居住地与妇女受教育程度之间存在交互作用(p结论):妇女(年龄、教育程度、职业、出生编号、上网情况、参与决策情况)、家庭(丈夫的教育程度、家庭财富)、医疗保健(产前保健就诊情况)和社区(居住地、地理区域)因素与遵守《综合家庭护理战略》的总体情况有关。这些因素在根深蒂固的社会经济不平等的复杂网络中影响着对综合婴儿保健服务的坚持。因此,旨在提高对综合婴儿保健服务的依从性的计划和干预措施应以育龄妇女及其家庭为目标,尤其是那些来自居住在农村地区的社会经济弱势群体的妇女及其家庭。
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来源期刊
Rural and remote health
Rural and remote health Rural Health-
CiteScore
2.00
自引率
9.50%
发文量
145
审稿时长
8 weeks
期刊介绍: Rural and Remote Health is a not-for-profit, online-only, peer-reviewed academic publication. It aims to further rural and remote health education, research and practice. The primary purpose of the Journal is to publish and so provide an international knowledge-base of peer-reviewed material from rural health practitioners (medical, nursing and allied health professionals and health workers), educators, researchers and policy makers.
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