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Iron supplementation in children to prevent deficiency and anaemia: A qualitative synthesis
Denny Mabetha1, Idriss I Kallon, Marianne Visser
1MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; and Health Systems Research Unit, South African Medical Research Council, Cape Town. denny.mabetha@wits.ac.za.
Insights
Preventive oral iron supplements for children are crucial but face challenges. Caregiver knowledge, healthcare support, and socioeconomic factors significantly influence their acceptance, feasibility, and equity in low- and middle-income countries.
Area of Science:
- Global Health
- Pediatric Nutrition
- Qualitative Research
Background:
- Iron deficiency anaemia is a significant global health issue in young children, especially in low- and middle-income countries (LMICs).
- The World Health Organization (WHO) recommends oral iron supplementation to combat iron deficiency and anaemia in high-prevalence areas.
Purpose of the Study:
- To explore factors affecting the acceptability, feasibility, and equity of preventive oral iron supplementation for young children.
- To inform evidence-based, locally relevant guideline development for the Global Evidence, Local Adaptation (GELA) project in sub-Saharan Africa.
Main Methods:
- A qualitative evidence synthesis was conducted using thematic analysis.
- Searches were performed across multiple databases (MEDLINE, Epistemonikos, CINAHL, PsycInfo) up to July 2023.
- Methodological quality and confidence in findings were assessed using adapted CASP and GRADE-CERQual tools.
Main Results:
- Caregiver acceptance is influenced by knowledge, perceptions, and provider relationships (moderate to high confidence).
- Community-based education can enhance acceptance, while lack of reliable information may hinder it (moderate confidence).
- Healthcare worker support improves feasibility (moderate confidence), but socioeconomic challenges impact equity (low confidence).
Conclusions:
- Contextual factors significantly influence the provision and uptake of oral iron supplementation in young children.
- Tailoring interventions to local contexts is essential for successful implementation.
Background:
Iron deficiency anaemia in young children is a major problem globally, particularly in low- and middle-income countries (LMICs). The World Health Organization (WHO) recommends preventive oral iron supplements to reduce the prevalence of iron deficiency and anaemia in high-prevalence settings.
Aim:
To conduct a qualitative evidence synthesis exploring the factors influencing the acceptability, feasibility and equity of preventive oral iron supplementation in young children for the Global Evidence, Local Adaptation (GELA) project, which supports the development of evidence-informed, locally relevant guideline recommendations in three sub-Saharan countries.
Method:
We searched MEDLINE, Epistemonikos, CINAHL and PsycInfo from inception to 07 July 2023 for eligible studies. We synthesised the data using thematic analysis and assessed the methodological quality of the studies (using an adaptation of the Critical Appraisal Skills Programme tool) and confidence in the review findings (using GRADE-CERQual).
Results:
We included six studies, five from LMICs. Findings indicated knowledge and perceptions about iron supplementation, as well as relationships with intervention providers, can have a beneficial or detrimental influence on caregiver acceptance (moderate to high confidence); caregiver acceptance may be negatively affected by a lack of reliable information but can potentially be enhanced through community-based education (moderate confidence); healthcare workers' knowledge, resources and support may improve the feasibility of intervention provision (moderate confidence) and socio-economic challenges around access to the intervention may adversely affect equity (low confidence).
Conclusion:
A complex interplay of contextual factors may impact the provision and uptake of preventive oral iron supplementation in young children.Contribution: This work provides insights into how preventative oral iron supplementation might be contextually tailored.
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