| ObjectTo understanding the implementation status and influencing factors of maternal anemia intervention measures in China,analyzes the obstacles and bottlenecks in the implementation process of maternal anemia intervention measures,so as to provide scientific basis for policy makers.Method1 Literature research:Through literature search to understand the current situation of maternal anemia at home and abroad,influencing factors and the implementation of intervention measures.2 Quantitative research:Six provinces(autonomous regions)every provincein in the east,central and west region of China were selected as the research areas.From October 2019 to February 2020,a questionnaire survey was conducted among 42 medical institutions in the research areas,and 201 medical staff and 1714 pregnant women in these institutions were investigated.From December 2019 to May 2020,a questionnaire survey was conducted among 2713 mothers of children aged 0-6 in three provinces of Eastern,central and Western China.3 Qualitative research:January to February 2021,four counties in four provinces of eastern,central and western in China were selected as the research areas.35 medical staffs and 33 pregnant women in the research area were interviewed.4 Bottleneck analysis:Through the bottleneck analysis method,this paper analyzes the implementation status and influencing factors of maternal anemia intervention measures in China from four aspects of supportive environment,supplier,demander and service quality,and finds out the obstacles and bottlenecks affecting maternal anemia intervention measures in China.Results1 Supportive environmentNational policies such as Tutorial for Outline of Healthy China 2030 Plan,National Nutrition Plan(2017-2030),Healthy China Action(2019-2030)provide favorable policy support environment for improving maternal nutrition and reducing maternal anemia.2 Service provider2.1 Medical institutions:All the investigated medical institutions can detect hemoglobin,and only 66.7%of them can detect ferritin.On average,each institution is equipped with 2.8 kinds of iron and 1.4 kinds of folic acid.Provincial medical institutions are equipped with the most kinds of iron and folic acid,with 5.3 kinds and2.3 kinds respectively.Township medical institutions are equipped with less kinds of iron and folic acid,with 1.2 kinds and 1.1 kinds respectively,compared with the eastern and central regions,there were only 1.9 kinds of iron and 1.3 kinds of folic acid in the western regions.2.2Medical staff:Only 47.3%of the doctors knew the prevalence of anemia in pregnant women.All the doctors surveyed asked pregnant women to test hemoglobin,and 87.6%of them asked to test ferritin.41.3%of doctors recommended iron supplement during the whole pregnancy.The most common iron supplement and folic acid supplement were polysaccharide iron complex(66.7%)and folic acid tablets(89.6%).79.1%of the doctors had participated in the training.3 Service demander95.2%of maternal had hemoglobin testduring pregnancy,while only 47.9%had ferritin test.10.8%of maternal with anemia did not receive any treatment from doctors,and only 23.4%of maternal with anemia received dietary guidance and iron and folic acid supplements at the same time.The proportion of pregnant women eating fresh vegetables and fruits every day is relatively high,but only 24.3%of them eat red meat every day,and only 38.3%of them ate animal blood or liver and kidney once a week or more.The supplement rates of folic acid,iron,vitamin,calcium and other minerals were 91.1%,38.1%,49.7%,55.2%and 21.8%respectively.Logistic regression results showed that eastern region,western region,northern region,middle pregnancy women,late pregnancy women,puerpera,those who had been tested for ferritin during pregnancy,anemia and iron deficiency were protective factors of iron supplement during pregnancy;Central region,South,early pregnant women,no detection of ferritin,no anemia and no iron deficiency were risk factors for iron supplementation during pregnancy.The qualified rate of anemia related knowledge was 85.5%,88.8%of them got knowledge from doctors.69.1%of the mothers the correct rate of vitamins that can promote iron absorption,and 59.3%of them got it from doctors.ConclusionThere are four bottlenecks in the implementation of intervention measures for maternal anemia.1 Supportive environment:Lack of uniform and recognized technical guidelines for anemia prevention in pregnant and lying in women;Some rigid policies limit the effective implementation of anemia control measures;The imbalance of economic development is still an important factor restricting the implementation of anemia prevention and control measures for pregnant women;The traditional diet culture limits the effective implementation of prevention and control measures to a certain extent.2 Service provision:Lack of ferritin detection ability in primary medical institutions;There are few kinds of iron and folic acid,and the popularization of preventive dose is low;Doctors do not pay enough attention to maternal anemia;The knowledge and consciousness of taking intervention measures are not strong.3 Service demand:The diet structure of pregnant women is unreasonable;Inadequate cognition of nutrition and anemia among pregnant women and mothers of children;The compliance of pregnant women to anemia prevention and treatment measures is insufficient.4 Service quality:the lack of routine testing;The supplement of iron folic acid preparation was not standardized;The treatment needs to be further improved.Therefore,according to the above bottlenecks,it is suggested to form a national unified technical guide for maternal anemia,and form a targeted prevention and treatment strategy for maternal anemia;Improve the detection ability of ferritin in primary medical institutions;Promoting the accessibility of preventive agents;Strengthen the training of doctors on the harm and prevention measures of maternal anemia;Through a variety of ways and the use of existing resources to increase the strength of health education for pregnant women. |
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