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