Contextualizing adherence: Iron supplementation treatment among Peruvian caretakers and their anemic children

This article describes an ethnographic study of adherence to iron supplementation protocols in 50 anemic preschoolers and their caregivers living in a peri-urban district in Lima, Peru. I use aspects of the syndemic approach to highlight the challenges caregivers face in following the recommended treatment and burden of treatment theory to develop a deeper understanding of adherence in a community with persistent childhood anemia. Interpreting adherence as an ideology also helps illuminate how health professionals' claims about patient behavior reflect social inequalities. Thematic analysis of qualitative data identified three major challenges to iron supplementation adherence-time constraints, acute health concerns, and child agency. These themes show how socioeconomic conditions and emotional burdens impact caregivers' ability to follow the prescribed treatment. Despite these challenges, the relatively high rate of adherence contests assumptions that lack of adherence is the primary explanation for persistent anemia rates among preschoolers living in this community.