Time for change is now: Experiences of participants in a community-based approach for iron and folic acid supplementation in a rural county in Kenya, a qualitative study

Abstract

Background Iron and Folic Acid Supplementation (IFAS) is recommended by World Health Organization as part of antenatal care to prevent anaemia in pregnancy. In 2010, Kenya adopted this recommendation and the current policy is to provide one combined IFAS tablet for daily use throughout pregnancy, free of charge, in all public health facilities. However, adherence remains low over the years though anaemia in pregnancy remains high. Integration of IFAS into community-based interventions has been recommended because of its excellent outcome. Using Community Health Volunteers (CHVs) to distribute IFAS has not been implemented in Kenya before. Methods Following an intervention study implementing a community-based approach for IFAS in five public health facilities in Lari Sub-County, 19 interviews were conducted among CHVs, nurses and pregnant women participating to describe their experiences. Thematic analysis of data was done using NVivo and findings described, with use of quotes. Findings The nurses, CHVs and pregnant women were all positive and supportive of communitybased approach for IFAS. They reported increased access and utilization of both IFAS and antenatal services leading to perceived reduction in anaemia and better pregnancy outcomes. Counselling provided by CHVs improved IFAS knowledge among pregnant women and consequent adherence. The increased IFAS utilization led to main challenge experienced being IFAS stock-outs. All participants recommended complementing antenatal IFAS distribution approach with community-based approach for IFAS.

Knowledge and awareness of folic acid usage in Saudi pregnant women in Riyadh city from 2019-2020

“…Maternal nutrition during pregnancy plays a vital factor and the World Health Organization (WHO) has recommended the folic acid (FA) supplementation usage towards the pregnant women to prevent the anemia and fetal complications. [ 1 2 3 ] A mixture of a balanced diet includes carbohydrates, vitamins, proteins, and minerals are essential during pregnancy. [ 4 5 6 ] Supplementation of various micronutrient consists of vitamins and minerals which will fill a gap during pregnancy.…”

Nurses’ perceptions of using volunteer support in health care settings: A systematic scoping review

“…The quality appraisals are summarised in Table 1. There were five purely qualitative studies (Ervin & Moore, 2014; Kamau, 2020; Ng et al., 2013; Tamin et al., 2021; Wong Shee et al., 2014). One study was both analytical cross sectional and qualitative (Claxton‐Oldfield et al., 2008).…”

“…One nurse in Bateman et al (2016) felt that volunteers interfered with patient care although no details were provided. For the nurses in Kamau (2020), the community health volunteers were a 'mixed blessing' , in that, the volunteerdriven increased uptake of nutritional supplements and engagement with the health service resulted in a shortage of supplements and an increased patient load for the nurses. The most negative attitudes to volunteers were again expressed in Ng et al (2013), where most nurses failed to see any potential benefit of expert user volunteers in rehabilitation or staff training.…”

“…Further, two studies highlighted that while there may be a role for volunteers, the tasks performed were also still part of the nurse's role (Huang et al, 2015;Kamau, 2020), with one nurse noting '… the health professionals are much better, we cannot solely give the responsibility to the [volunteers]' (Kamau, 2020, p12). Kamau (2020) highlighted the need for integration of hospital and community volunteer approaches. Integration was also valued in Bateman et al (2016), with one nurse noting 'I believe it [volunteer care] complemented what we did really well' (p9).…”

“…Only five studies reported results related to volunteer recruitment and training, with mixed findings. Kamau (2020) found nurses were impressed and encouraged by the training provided to volunteers. Hospice palliative care nurses in Claxton-Oldfield et al (2008) overall agreed that volunteers were carefully selected and had completed a training program; however, about three quarters of nurses were unsure about the content of the training.…”