Determinants of compliance with iron supplementation: Supplies, side effects, or psychology?

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Abstract

Iron deficiency anemia affects over 2 billion people. Particularly at risk are pregnant women and young children. Although distribution of iron supplements is practised in many antenatal care programs in developing countries, it has often been alleged that pregnant women do not take them. Poor compliance arises not only because of patient behavior but also from factors out of the patient's control. This paper presents the results of a review of the literature on medical compliance to determine whether iron supplementation is different from other medications, to assess the known levels of compliance, and to synthesize recommendations for improving compliance relevant to iron supplementation.

The review showed that compliance with iron therapy is a specific case of medical compliance. Reasons for non-compliance with iron deficiency treatment include: inadequate program support (lack of political commitment and financial support); insufficient service delivery (poor provider-user dynamics; lack of supplies, access, training, and motivation of health care professionals); and patient factors (misunderstanding instructions, side effects, frustration about the frequency and number of pills taken, migration, fear of having big babies, personal problems, nausea that accompanies pregnancy, and the subtlety of anemia which makes demand for treatment low). Much has been made about the side effects (nausea, constipation, etc.) that women might experience during iron therapy as the cause of poor compliance with iron supplementation without justification according to this review. Instead, unavailability of iron supplements was the most common reason why women did not take iron supplements.

Women bear a disproportionate burden from iron deficiency anemia even though the technology exists to address the problem at low cost. Governments and health care professionals must renew their commitment to iron therapy by monitoring and improving compliance. We can significantly improve compliance by: making sure that iron supplements are available at all times; providing advanced warning about the possibility of side effects; involving the patient in the therapeutic strategy; and providing reminders, such as posters and calendars, about taking supplements.

References (69)

  • K. Kolton et al.

    Patient compliance: a challenge in practice

    Nurse Pract.

    (1988)
    K. Kolton et al.

    Patient compliance: a challenge in practice

    Nurse Pract.

    (1988)
    K. Kolton et al.

    Patient compliance: a challenge in practice

    Nurse Pract.

    (1988)
    K. Kolton et al.

    Patient compliance: a challenge in practice

    Nurse Pract.

    (1988)
  • S. Siriboon et al.

    Who forgets to take the pill? The Thai experience

    Int. Family Planning Perspect.

    (1990)
  • I. Blot et al.

    Influence of routine administration of folic acid and iron during pregnancy

    Gynecol. Obstet. Invest.

    (1981)
  • M. Griffiths

    Volume I: Concept Testing Nutrition Communication and Behavior Change Components

  • F. Woolley et al.

    The effects of doctor-patient communication on satisfaction and outcome of care

    Soc. Sci. Med.

    (1978)
  • Htoon M., Bartolli J. and Kosasih L. Leprosy. Disease Control Priorities in Developing Countries (Edited by Jamison D....
  • World Health Organization

    National strategies for overcoming micronutrient malnutrition

  • E. DeMaeyer et al.

    The prevalence of anemia in the world

    Rapp. trimest. statist. sanit. Mond.

    (1985)
  • H. Levin et al.

    Micronutrient deficiency disorders

  • ACC/SCN

    Controlling iron deficiency. A report based on an ACC/SCN workshop

    Nutrition policy discussion paper no. 9

    (1991)
  • O. Morrow

    Iron Supplementation During Pregnancy: Why aren't Women Complying? A Review of Available Literature

  • C. Abou-Zahr

    Non-compliance: a major problem in anaemia control

    Essential Drugs Monitor

    (1990)
  • W. Fox

    Compliance of patients and physicians: experience and lessons from tuberculosis—I

    Br. Med. J.

    (1983)
    W. Fox

    Compliance of patients and physicians: experience and lessons from tuberculosis—II

    Br. Med. J.

    (1983)
  • D. Morrow et al.

    Adherence and medical instruction: review and recommendations

    JAGSA

    (1988)
  • R. Haynes

    Introduction

  • P. Conrad

    The noncompliant patient in search of autonomy

    Hasting Center Report

    (August, 1987)
  • Guidelines for the Control of Maternal Nutritional Anemia

  • A. Jonsen

    Ethical issues in compliance

  • L. Gordis

    Conceptual and methodologic problems in measuring patient compliance

  • A. Fleming et al.

    Effects of iron and folic acid antenatal supplements on maternal haematology and fetal well-being

    Med. J. Aust.

    (1974)
  • L. Iyengar et al.

    Prophylaxis of anemia in pregnancy

    Am. J. clin. Nutr.

    (1970)
  • E. Bowles

    Personal Communication

    (1990)
  • S. Eraker et al.

    Understanding and improving patient compliance

    Ann. Int. Med.

    (1984)
  • J. Trostle

    Medical compliance as an ideology

    Soc. Sci. Med.

    (1988)
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