Empowering Community Health Volunteers as a Strategy to Prevent Anemia in Pregnant Women: A Quasi-Experimental Study

Authors

  • Diana Rosalina Sentuf Department of Midwifery, Graduate School, Hasanuddin University, Makassar, South Sulawesi, Indonesia
  • Jumrah Department of Midwifery, Graduate School, Hasanuddin University, Makassar, South Sulawesi, Indonesia
  • Hasta Handayani Idrus Department of Biomedical Science, Faculty of Medicine, Hasanuddin University, Makassar, South Sulawesi, Indonesia
  • Stang Department of Public Health Sciences, Faculty of Public Health, Hasanuddin University, Makassar, South Sulawesi, Indonesia
  • Darmawansyah Department of Public Health Sciences, Faculty of Public Health, Hasanuddin University, Makassar, South Sulawesi, Indonesia

DOI:

https://doi.org/10.55489/njcm.161020255672

Keywords:

Community health volunteers’ empowermen, Iron supplement tablets, Adherence, Hemoglobin, Anemia, Pregnant women

Abstract

Background: Pregnancy anemia is a significant public health issue causing postpartum hemorrhage, premature birth, and low birth weight. Empowering community health volunteers could improve compliance and improve hemoglobin levels.

Methodology: The study investigates the impact of community health volunteer’s empowerment on adherence to iron supplement tablets tablet consumption and hemoglobin levels. the sample size is 62 third-trimester pregnant women (31 per group) for precision standard care using only the Maternal and Child Health book without cadre assistance. The Morisky Medication Adherence Scale-8 questionnaire was used to assess compliance. Data analysis included Chi-square and Paired Sample T test.

Results: Adherence to blood tablet consumption increased significantly in the intervention group compared to the control group with a significant value of p <0.001. Hemoglobin levels also increased significantly (p-value = 0.001), and adherence to the consumption of iron supplement tablets influenced hemoglobin levels (p-value = 0.003).

Conclusion: Empowering cadres in primary health facilities is effective in increasing compliance with iron supplement tablets tablet consumption, which impacts hemoglobin levels in third-trimester pregnant women.

References

Naz S, Shahid S, Noorani S, Fatima I, Jaffar A, Kashif M, et al. Management of iron deficiency anemia during pregnancy: a midwife-led continuity of care model. Front Nutr. 2024;11:1400174. DOI: https://doi.org/10.3389/fnut.2024.1400174 PMid:38854160 PMCid:PMC11157065

Zhang Q, Lu XM, Zhang M, Yang CY, Lv SY, Li SF, Zhong CY, Geng SS. Adverse effects of iron deficiency anemia on pregnancy outcome and offspring development and intervention of three iron supplements. Sci Rep. 2021 Jan 14;11(1):1347. DOI: https://doi.org/10.1038/s41598-020-79971-y PMid:33446747 PMCid:PMC7809104

Bryszewska MA. Comparison Study of Iron Bioaccessibility from Dietary Supplements and Microencapsulated Preparations. Nutrients. 2019 Jan 26;11(2):273. DOI: https://doi.org/10.3390/nu11020273 PMid:30691123 PMCid:PMC6412228

Zhao X, Zhang X, Xu T, Luo J, Luo Y, An P. Comparative Effects between Oral Lactoferrin and Ferrous Sulfate Supplementation on Iron-Deficiency Anemia: A Comprehensive Review and Meta-Analysis of Clinical Trials. Nutrients. 2022 Jan 27;14(3):543. DOI: https://doi.org/10.3390/nu14030543 PMid:35276902 PMCid:PMC8838920

Ndiaye NF, Owais A, Diop H, Lee C, Merritt CE, González-Fernández D, Diouf A, Dossou NI, Rattan P, Bhutta ZA. Drivers of anemia reduction among women of reproductive age in Senegal: a country case study. Am J Clin Nutr. 2025 Apr;121 Suppl 1:S8-S21. DOI: https://doi.org/10.1016/j.ajcnut.2024.05.031 PMid:38908516

Efendi F, Israfil I, Ramadhan K, McKena L, Alem A, Malini H. Factors associated with receiving iron supplements during pregnancy among women in Indonesia. Electron J Gen Med. 2023;20(5):em506. DOI: https://doi.org/10.29333/ejgm/13266

Pusporini AD, Salmah AU, Wahyu A, Seweng A, Indarty A, Suriah, Nur R, Syam A, Mahfudz. Risk factors of anemia among pregnant women in community health center (Puskesmas) Singgani and Puskesmas Tipo Palu. Gac Sanit. 2021;35 Suppl 2:S123-S126. DOI: https://doi.org/10.1016/j.gaceta.2021.10.010 PMid:34929793

Helmyati S, Syarifa CA, Rizana NA, Sitorus NL, Pratiwi D. Acceptance of Iron Supplementation Program among Adolescent Girls in Indonesia: A Literature Review. Amerta Nutr. 2023;7(3SP):50-61. DOI: https://doi.org/10.20473/amnt.v7i3SP.2023.50-61

Noptriani S, Simbolon D. Probability of non-compliance to the consumption of Iron Tablets in pregnant women in Indonesia. J Prev Med Hyg. 2022 Oct 27;63(3):E456-E463. DOI: https://doi.org/10.15167/2421-4248/jpmh2022.63.3.2340 PMID: 36415291 PMCID: PMC9648554

Kuntari T, Supadmi S. Anemia in young pregnant women: A cross-sectional study in Indonesia. JKKI. 2024 Aug. 27;15(2):147-161. Available from: https://journal.uii.ac.id/JKKI/article/view/33162

Frumence G, Goodman M, Chebet JJ, Mosha I, Bishanga D, Chitama D, Winch PJ, Killewo J, Baqui AH. Factors affecting early identification of pregnant women by community health workers in Morogoro, Tanzania. BMC Public Health. 2019 Jul 8;19(1):895. DOI: https://doi.org/10.1186/s12889-019-7179-1 PMid:31286930 PMCid:PMC6615291

Mhlongo EM, Lutge E, Adepeju L. The roles, responsibilities and perceptions of community health workers and ward-based primary health care outreach teams: a scoping review. Glob Health Action. 2020 Dec 31;13(1):1806526. DOI: https://doi.org/10.1080/16549716.2020.1806526 PMid:32892739 PMCid:PMC7782342

Moon SJ, Lee WY, Hwang JS, Hong YP, Morisky DE. Accuracy of a screening tool for medication adherence: A systematic review and meta-analysis of the Morisky Medication Adherence Scale-8. PLoS One. 2017 Nov 2;12(11):e0187139. DOI: https://doi.org/10.1371/journal.pone.0187139. Erratum in: PLoS One. 2018 Apr 17;13(4):e0196138. DOI: https://doi.org/10.1371/journal.pone.0196138 PMID: 29095870 PMCID: PMC5667769.

Singh JK, Acharya D, Paudel R, Gautam S, Adhikari M, Kushwaha SP, Park JH, Yoo SJ, Lee K. Effects of Female Community Health Volunteer Capacity Building and Text Messaging Intervention on Gestational Weight Gain and Hemoglobin Change Among Pregnant Women in Southern Nepal: A Cluster Randomized Controlled Trial. Front Public Health. 2020 Jul 17;8:312. DOI: https://doi.org/10.3389/fpubh.2020.00312 PMid:32766199 PMCid:PMC7379845

Yorick R, Khudonazarov F, Gall AJ, Pedersen KF, Wesson J. Volunteer Community Health and Agriculture Workers Help Reduce Childhood Malnutrition in Tajikistan. Glob Health Sci Pract. 2021 Mar 15;9(Suppl 1):S137-S150. DOI: https://doi.org/10.9745/GHSP-D-20-00325 PMid:33727326 PMCid:PMC7971367

Arnaert A, Ponzoni N, Debe Z, Meda MM, Nana NG, Arnaert S. Experiences of women receiving mhealth-supported antenatal care in the village from community health workers in rural Burkina Faso, Africa. Digit Health. 2019 Dec 1;5:2055207619892756. DOI: https://doi.org/10.1177/2055207619892756 PMid:31832224 PMCid:PMC6891107

Bridge R, Lin TK. Evidence on the impact of community health workers in the prevention, identification, and management of undernutrition amongst children under the age of five in conflict-affected or fragile settings: a systematic literature review. Confl Health. 2024 Feb 27;18(1):16. DOI: https://doi.org/10.1186/s13031-024-00575-8 PMid:38413996 PMCid:PMC10900658

Nagraj S, Hinton L, Praveen D, Kennedy S, Norton R, Hirst J. Women's and healthcare providers' perceptions of long-term complications associated with hypertension and diabetes in pregnancy: a qualitative study. BJOG. 2019 Aug;126 Suppl 4(Suppl Suppl 4):34-42. DOI: https://doi.org/10.1111/1471-0528.15847 PMid:31257668 PMCid:PMC6771686

Orji BC, Bryce E, Odio B, Onuoha HE, Njoku E, Anoke C, Ugwa E, Enne J, Oniyire A, Otolorin E, Afolabi K, Ogbulafor NC, Oliveras E. Retrospective evaluation of referral by community health workers on the uptake of intermittent preventive treatment of Malaria in pregnancy in Ohaukwu, Ebonyi State, Nigeria. BMC Pregnancy Childbirth. 2022 Jul 27;22(1):599. DOI: https://doi.org/10.1186/s12884-022-04921-7 PMid:35896992 PMCid:PMC9327266

Soepnel LM, Mabetha K, Norris SA, Motlhatlhedi M, Nkosi N, Klingberg S, Lye S, Draper CE. The role of a community health worker-delivered preconception and pregnancy intervention in achieving a more positive pregnancy experience: the Bukhali trial in Soweto, South Africa. BMC Womens Health. 2024 Mar 5;24(1):161. DOI: https://doi.org/10.1186/s12905-024-02982-8 PMid:38443924 PMCid:PMC10916028

Bhutta ZA, Keats EC, Owais A, González-Fernández D, Udomkesmalee E, Neufeld LM, Izadnegahdar R, Kassebaum N, Fairweather-Tait S, Branca F, Christian P, Fawzi W. What works for anemia reduction among women of reproductive age? Synthesized findings from the exemplars in anemia project. Am J Clin Nutr. 2025 Apr;121 Suppl 1:S68-S77. DOI: https://doi.org/10.1016/j.ajcnut.2024.11.031 PMid:40204412

Babah OA, Beňová L, Hanson C, Abioye AI, Larsson EC, Afolabi BB. Screening and treatment practices for iron deficiency in anaemic pregnant women: A cross-sectional survey of healthcare workers in Nigeria. PLoS One. 2024 Nov 21;19(11):e0310912. DOI: https://doi.org/10.1371/journal.pone.0310912 PMid:39570864 PMCid:PMC11581334

Olaniran A, Madaj B, Bar-Zev S, van den Broek N. The roles of community health workers who provide maternal and newborn health services: case studies from Africa and Asia. BMJ Glob Health. 2019 Aug 10;4(4):e001388. DOI: https://doi.org/10.1136/bmjgh-2019-001388 PMid:31478012 PMCid:PMC6703286

Sarma H, Mbuya MN, Tariqujjaman M, Rahman M, Askari S, Khondker R, Sultana S, Shahin SA, Bossert TJ, Banwell C, Neufeld LM, Ahmed T, D'Este C. Role of home visits by volunteer community health workers: to improve the coverage of micronutrient powders in rural Bangladesh. Public Health Nutr. 2021 Apr;24(S1):s48-s58. DOI: https://doi.org/10.1017/S1368980020000038 PMid:32131922 PMCid:PMC8042577

Mohebi S, Parham M, Sharifirad G, Gharlipour Z, Mohammadbeigi A, Rajati F. Relationship between perceived social support and self-care behavior in type 2 diabetics: A cross-sectional study. J Educ Health Promot. 2018 Apr 3;7:48. DOI: https://doi.org/10.4103/jehp.jehp_73_17 PMid:29693029 PMCid:PMC5903155

Geldsetzer P, Mboggo E, Larson E, Lema IA, Magesa L, Machumi L, et al. Community health workers to improve uptake of maternal healthcare services: A cluster-randomized pragmatic trial in Dar es Salaam, Tanzania. PLoS Med. 2019 Mar 29;16(3):e1002768. DOI: https://doi.org/10.1371/journal.pmed.1002768 PMid:30925181 PMCid:PMC6440613

Nabila N, Andriani H. Examining the Implementation of Blood Supplement Tablet Policy as a Strategy for Stunting Prevention: Insights from High and Low Coverage Health Centers in Medan City. Open Public Health J, 2025;18:e18749445379272. DOI: http://dx.doi.org/10.2174/0118749445379272250316081326

Qurrota A, Al AY, Afridah W, Soenaryo M. Santri Husada Cadres Empowerment Promotive and Preventive Agents at Pondok Pesantren Jabal Noer. Community Dev J. 2023;7(3):120-129.

Noor MS, Sari AR, Akbar Agustriyanto R, Norwinardi R, Agustina D, Rahmaniah E, et al. Role of cadre in improving knowledge and attitude of chronic energy deficiency on teenagers in Mali-Mali village, Banjar regency, south Kalimantan, Indonesia. Open Access Maced J Med Sci. 2021;9(E):145-149. DOI: https://doi.org/10.3889/oamjms.2021.5664

Hein ZNM, Maung TM, Aung PP, Mon NO, Han WW, Oo T, Linn NYY, Thi A, Wai KT. Do we need to go further to train healthcare providers in the targeted regions for malaria elimination in Myanmar? A mixed-methods study. Trop Med Health. 2020 Feb 21;48:11. DOI: https://doi.org/10.1186/s41182-020-00196-w PMid:32123518 PMCid:PMC7035698

Schunk DH, DiBenedetto MK. Motivation and social cognitive theory. Contemp Educ Psychol. 2020;60:101832. DOI: https://doi.org/10.1016/j.cedpsych.2019.101832

Nurjanna, Syafar M, Syria, Thaha RM, Salam A, Amiruddin R, et al. Peer Group Empowerment to Improve Teenagers' Behavior in Consuming Blood Supplement Tablets Through the Youth Integrated Healthcare Center Program. Pharmacogn J . 2024;16(2):400-404. DOI: https://doi.org/10.5530/pj.2024.16.62

Morrison J, Giri R, Arjyal A, Kharel C, Harris-Fry H, James P, Baral S, Saville N, Hillman S. Addressing anaemia in pregnancy in rural plains Nepal: A qualitative, formative study. Matern Child Nutr. 2021 Jul;17(Suppl 1):e13170. DOI: https://doi.org/10.1111/mcn.13170 PMid:34241951 PMCid:PMC8269150

Lutfiasari D, Martini S, Widati S, Fatmaningrum W. Effective communication methods in preventing anaemia in adolescents: A systematic review. Afr J Reprod Health. 2024 Oct 31;28(10s):318-331. DOI: https://doi.org/10.29063/ajrh2024/v28i10s.35 PMid:39640840

Chehrazi M, Faramarzi M, Abdollahi S, Esfandiari M, Shafie Rizi S. Health promotion behaviours of pregnant women and spiritual well-being: Mediatory role of pregnancy stress, anxiety and coping ways. Nurs open. 2021;8(6):3558-65. DOI: https://doi.org/10.1002/nop2.905 PMid:33938639 PMCid:PMC8510764

Maykondo BK, Horwood C, Haskins L, Mapumulo S, Mapatano MA, Kilola BM, Mokanisa MB, Hatloy A, John VM, Bitadi PMBW. A qualitative study to explore dietary knowledge, beliefs, and practices among pregnant women in a rural health zone in the Democratic Republic of Congo. J Health Popul Nutr. 2022 Nov 22;41(1):51. DOI: https://doi.org/10.1186/s41043-022-00333-7 PMid:36414967 PMCid:PMC9682828

Downloads

Published

2025-10-01

How to Cite

1.
Sentuf DR, Jumrah, Idrus HH, Stang, Darmawansyah. Empowering Community Health Volunteers as a Strategy to Prevent Anemia in Pregnant Women: A Quasi-Experimental Study. Natl J Community Med [Internet]. 2025 Oct. 1 [cited 2025 Oct. 1];16(10):1008-16. Available from: https://njcmindia.com/index.php/file/article/view/5672

Issue

Section

Original Research Articles

Similar Articles

<< < 155 156 157 158 159 160 

You may also start an advanced similarity search for this article.

Most read articles by the same author(s)