Evaluating Malaysian Government Primary Healthcare Workers Knowledge, Attitude and Practice in Managing Iron Deficiency Anaemia during Pregnancy

Beatrice J. N. L. *

Kampung Bandar Health Clinic, Jalan Kurau, 42500 Kuala Langat, Selangor, Malaysia.

Manoharan A.

Bandar Botanik Health Clinic, Jalan Langat, 41200 Klang, Selangor, Malaysia.

Hazwan M. D.

Malaysian Research Institute on Ageing, Universiti Putra Malaysia, 43400 Serdang, Selangor, Malaysia.

Nurazrina A. A.

Rahmat Health Clinic, Kampung Rahmat, 21450 Chalok, Terengganu, Malaysia.

Zamzurina A.

Kuang Health Clinic, Batu 20, Mukim, Kuang, 48050 Rawang, Selangor, Malaysia.

Yew M. L.

Tanjung Sepat Health Clinic, Kampung Kundang, 42800 Kuala Langat, Selangor, Malaysia.

Koh W. M.

Rawang Health Clinic, Jalan Rawang Perdana, Taman Rawang Perdana, 48000 Rawang, Selangor, Malaysia.

Nadia A. G.

Tanjung Malim Health Clinic, Jalan Ketoyong, 35900 Tanjung Malim, Perak, Malaysia.

Jazlan J.

Sauk Health Clinic, Jalan Besar Lenggong, 33500 Kuala Kangsar, Perak, Malaysia.

*Author to whom correspondence should be addressed.


Abstract

Introduction: Management of iron deficiency anaemia (IDA) in pregnancy remains suboptimal. This study aimed to develop a tool and determine the knowledge, attitude, and practice (KAP) of primary healthcare providers and its associated factors using a newly developed validated questionnaire.

Methodology: A validation study was conducted among 159 Perak government primary healthcare doctors and nurses. Cronbach’s alpha, factor analysis, face validation and test-retest were performed.  Subsequently, a cross-sectional study was conducted among 435 doctors and nurses in Selangor, Johor, and Terengganu from October to December 2023. Association between socio-demographics, clinical experience, organizational support, and attitude with the knowledge and practices were analyzed using logistic regression.

Results: The final Health Care Providers Knowledge, Attitude and Practice- Iron Deficiency Anaemia (HCPKAP-IDA) questionnaires had 28 items. A good internal consistency was observed; Cronbach’s alpha (0.781-0.859), factor loading; attitude (0.490-0.811), and practice (0.444-0.841). Using HCPKAP-IDA, poor knowledge (38.9%), attitude (46.9%), and practice (43%) scores were shown. The significant factors associated with the poor practice were female (OR=0.39, 95% CI 0.15- 0.99, p=0.049), had IDA (OR=0.74, 95% CI 1.34- 1.58, p=0.043), experienced Anaemic symptoms (OR=0.71, 95% CI 1.36- 1.40, p=0.032), took iron supplement (OR=0.62, 95% CI 1.70- 2.87, p=0.033), received training (OR=0.29, 95% CI 0.11- 0.74, p=0.010), availability of parenteral iron (OR=0.74, 95% CI 1.03- 1.28, p=0.027) and good attitude (OR=0.40, 95% CI 2.62- 6.01, p=0.001). The significant factors associated with poor knowledge were community nurses (OR=15.49, 95% CI 6.46- 37.11, p<0.001), staff nurses (OR=7.74, 95% CI 3.45- 17.39, p<0.001), and availability of guidelines (OR=0.18, 95% CI 0.05- 0.69, p=0.012).

Conclusion: Improving the knowledge of primary healthcare providers through training and the availability of parenteral iron in all primary care clinics nationwide should be advocated. A national guideline that incorporates quick algorithms and checklists should be considered.

Keywords: Knowledge, attitude, practice, anaemia, pregnancy, primary healthcare


How to Cite

Beatrice J. N. L., Manoharan A., Hazwan M. D., Nurazrina A. A., Zamzurina A., Yew M. L., Koh W. M., Nadia A. G., and Jazlan J. 2024. “Evaluating Malaysian Government Primary Healthcare Workers Knowledge, Attitude and Practice in Managing Iron Deficiency Anaemia During Pregnancy”. Asian Research Journal of Gynaecology and Obstetrics 7 (1):27-43. https://journalarjgo.com/index.php/ARJGO/article/view/208.

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References

Di Renzo GC, Spano F, Giardina I, Brillo E, Clerici G, Roura LC. Iron deficiency anemia in pregnancy. Womens Health (Lond). 2015;11(6):891–900.

World Health Organization (WHO). Anaemia in women and children.

Available:https://www.who.int/data/gho/data/themes/topics/anaemia_in_women_and_children

[Accessed on: 2024 Feb 9].

Shand AW, Kidson-Gerber GL. Anaemia in pregnancy: a major global health problem. Lancet. 2023;401(10388):1550–1.

Abd Rahman R, Idris IB, Isa ZM, Rahman RA, Mahdy ZA. The Prevalence and Risk Factors of Iron Deficiency Anemia Among Pregnant Women in Malaysia: A Systematic Review. Front Nutr. 2022;9: 847693.

Kumar P, Shah P, Awasthi V, Khera B, Agarwal M, Lakhtakia M, et al. Anemia in Pregnancy: A knowledge, Attitude and Practice Survey Amongst Obstetricians and Gynaecologists in India. J Obstet Gynaecol India. 2022;72(5):382–8.

Ministry of Health Malaysia. Perinatal Care Manual 4th Edition 2022 [Internet]. Available:Available:http://hsegamat.moh.gov.my/oasis/redirect.php?docid=979

O’Toole F, Sheane R, Reynaud N, McAuliffe FM, Walsh JM. Screening and treatment of iron deficiency anemia in pregnancy: A review and appraisal of current international guidelines. Int J Gynaecol Obstet; 2023.

Hospital Canselor Tuanku Muhriz PPUKM. Parenteral Iron therapy for iron deficiency anaemia in pregnancy. 2024;16(9).

Available:https://hctm.ukm.my/farmasi/wp-content/uploads/2020/09/9.2016.-parenteral-iron-therapy-for-ida-in-pregnancy.pdf

[Accessed on: 2024 Feb 9].

Abd Rahman R, Idris IB, Isa ZM, Rahman RA, Mahdy ZA. The prevalence and risk factors of iron deficiency anemia among pregnant women in Malaysia: A Systematic Review. Front Nutr. 2022;9:847693.

Ministry of Health Malaysia. Malaysia Health Technology Assessment Section (MaHTAS). Intravenous iron for iron deficiency anaemia; 2019.

Available:https://www.google.com/search?q=.+Malaysia+Health+Technology+Assessment+Section+(MaHTAS)+2019.+Intravenous+iron+for+iron+deficiency+anaemia.+pubmed&rlz=1C1GCEA_enMY927MY927&oq=.+Malaysia+Health+Technology+Assessment+Section+(MaHTAS)+2019.+Intravenous+iron+for+iron+deficiency+anaemia.+pubmed&gs_lcrp=EgZjaHJvbWUyBggAEEUYOdIBCTMyNzBqMGoxNagCALACAA&sourceid=chrome&ie=UTF-8

[Accessed on:2024 Feb 9].

Rahmawati S, Widiasih R, Maryati I. Factor Associated Anemia Among Pregnant Women: A Literature Review; 2022.

Kim Lam Soh, Eusni Rahayu Mohd Tohit, Salimah Japar, Soh Kim Geok. Anemia among Antenatal Mother in Urban Malaysia [Internet].

Available:https://www.scirp.org/journal/paperinformation?paperid=54772

[Accessed on: 2024 Feb 9].

Lee T, Chin Y, Lim PY, Ahmad Fuzi S. Associations of obstetrical characteristics and dietary intakes with iron status among pregnant women in Selangor and Kuala Lumpur. British Food Journal; 2020.

Djibril M Ba, Paddy Ssentongo, Kristen H Kjerulff, Muzi Na. Adherence to iron supplementation in 22 Sub-Saharan African Countries and Associated Factors among Pregnant Women: A Large Population-Based Study.

Available:https://pubmed.ncbi.nlm.nih.gov/31777771/

[Accessed on: 2024 Feb 9].

Fouelifack FY, Sama JD, Sone CE. Assessment of adherence to iron supplementation among pregnant women in the Yaounde gynaeco-obstetric and paediatric hospital. Pan Afr Med J. 2019;34:211.

Jikamo B, Samuel M. Non-adherence to iron/folate supplementation and associated factors among pregnant women who attending antenatal Care Visit in Selected Public Health Institutions at Hosanna Town, Southern Ethiopia, 2016. J Nutr Disorders Ther; 2018.

Available:https://www.omicsonline.org/open-access/nonadherence-to-ironfolate-supplementation-and-associated-factors-among-pregnant-women-who-attending-antenatal-care-visit-in-selec-2161-0509-1000230-101330.html

[Accessed on: 2024 Feb 9];08(02)

Ghimire N, Pandey N. Knowledge and practice of mothers regarding the prevention of Anemia during Pregnancy, in Teaching Hospital, Kathmandu. Journal of Chitwan Medical College. 2013; 3.