title: Impact of a positive deviance approach to improve the effectiveness of an iron-supplementation program to control nutritional anemia among rural Senegalese pregnant women.
abstract: BACKGROUND
  Iron supplementation through prenatal care remains the most widespread strategy to control anemia during pregnancy, but its effectiveness is only partial, showing the need to address other approaches.
  
  
  OBJECTIVE
  This study was conducted to measure the impact of a positive deviance approach to improve an iron-supplementation program among pregnant women in a rural Senegalese area.
  
  
  METHODS
  A positive deviance approach (PD Micah) was compared with an ongoing integrated nutrition and health program intervention (Micah) in a rural Senegalese area. A pre-post evaluation was conducted using independent cross-sectional samples with a total of 371 pregnant women. A sociodemographic questionnaire was administered, and biologic and anthropometric measurements were performed.
  
  
  RESULTS
  After 9 months of activities, the mean hemoglobin level rose from 93.9 to 100.7 g/L in the PD Micah group. Distribution of iron supplements through community volunteers and implementation of healthy pregnancy promotion sessions on a monthly basis improved the accessibility to 23.3% in the PD Micah group. No significant change was observed in the Micah group. Logistic regression analysis showed a significantly reduced risk of anemia in the PD Micah area (adjusted odds ratio, 0.25; 95% confidence interval, 0.12 to 0.53).
  
  
  CONCLUSIONS
  This intervention shows that a community-based strategy, such as the positive deviance approach, can contribute to improving the effectiveness of iron supplementation during pregnancy.
authors.affiliation: Université de Montreal, Québec, Canada.
authors.forename: Mamadou
authors.initials: M
authors.lastname: Ndiaye
authors.forename: Kendra
authors.initials: K
authors.lastname: Siekmans
authors.forename: Slim
authors.initials: S
authors.lastname: Haddad
authors.forename: Olivier
authors.initials: O
authors.lastname: Receveur
mesh_terms: D000293:Adolescent; D000328:Adult; D018798:Anemia, Iron-Deficiency / Q000150:complications / Q000188:drug therapy* / Q000378:metabolism; D003150:Community Health Workers; D003430:Cross-Sectional Studies; D019587:Dietary Supplements; D005260:Female; D006293:Health Promotion; D006454:Hemoglobins / Q000378:metabolism*; D006801:Humans; D007501:Iron / Q000008:administration & dosage / Q000627:therapeutic use*; D000090463:Iron Deficiencies; D019266:Iron, Dietary / Q000008:administration & dosage / Q000627:therapeutic use*; D016015:Logistic Models; D008288:Malaria / Q000150:complications / Q000378:metabolism / Q000469:parasitology; D008875:Middle Aged; D016017:Odds Ratio; D011247:Pregnancy; D011248:Pregnancy Complications / Q000188:drug therapy* / Q000378:metabolism; D011295:Prenatal Care; D012423:Rural Health; D012675:Senegal; D014131:Trace Elements / Q000008:administration & dosage / Q000172:deficiency / Q000627:therapeutic use*; D014838:Volunteers; D055815:Young Adult
chemical_list: D006454:Hemoglobins; D019266:Iron, Dietary; D014131:Trace Elements; D007501:Iron